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FLUORIDATION OF WATER
HEARINGS
BEFORE THE
COMMITTEE ON
INTERSTATE AND FOREIGN COMMERCE
HOUSE OF REPRESENTATIVES
EIGHTY-THIED CONGRESS
SECOND SESSION
ON
H. R. 2341
A BILL TO PROTECT THE PUBLIC HEALTH FROM THE
DANGERS OF FLUORINATION OF WATER
MAY 25, 26, AND 27, 1954
Printed for the use of the Committee on Interstate and Foreign Commerce
FLUORIDATION OF WATER
HEARINGS
BEFORE THE
c^,,^,^ ^uu--. COMMITTEE ON
INTERSTATE AND FOREIGN COMMERCE
HOUSE OF REPRESENTATIVES
EIGHTY-THIED CONGRESS
SECOND SESSION
ON
H. R. 2341
A BILL TO PROTECT THE PUBLIC HEALTH FROM THE
DANGERS OF FLUORIDATION OF WATER
MAY 25, 26, AND 27, 1954
Printed for the use of the Committee on Interstate and Foreign Commerce
Jort
Wa
Kleinfe.
Knutson,
Leone, Di
Institute
UNITED STATES
GOVERNMENT PRINTING OFFICE
. WASHINGTON : 1954
■ih
I?/!
Boston Public Library
Superintendent of Documents
SEP 8 -1954
• 0^^
COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE
CHARLES A. WOLVERTON, New Jersey, Chairman
CARL HINSIIAW, California
JOSEPH P. O'HARA, Minnesota
ROBERT HALE, Maine
JAMES I. DOLLIVER, Iowa
JOHN W. HESELTON, Massachusetts
JOHN B. BENNETT, Michigan
RICHARD W. HOFFMAN, Illinois
JOHN V. BEAMER, Indiana
WILLIAM L. SPRINGER, Illinois
ALVIN R. BUSH, Pennsylvania
PAUL F. SCHEXCK, Ohio
JOSEPH L. CARRIGG, Pennsylvania
HERBERT B. WARBURTON, Delaware
STEVEN B. DEROUNIAN, New York
THOMAS M. PELLY, Washington
J, ARTHUR YOUNGER, California
Elton J.
ROBERT GROSSER, Ohio
J. PERCY PRIEST, Tennessee
OREN HARRIS, Arkansas
DWIGHT L. ROGERS, Florida
ARTHUR G. KLEIN, New York
WILLIAM T. GRANAHAN, Pennsylvania
F. ERTEL CARLYLE, North Carolina
JOHN BELL WILLIAMS, Mississippi
PETER F. MACK, Jr., Illinois
HOMER THORNBERRY, Texas
LOUIS B. HELLER, New York
KENNETH A. ROBERTS, Alabama
MORGAN M. MOULDER, Missouri
HARLEY O. STAGGERS, West Virginia
Layton, Clerk
Professional Staff
KUET BORCHAEDT ANDREW STEVENSON
Sam G. Spal A. E. Stockburgbr
CONTENTS
Page
Text of H. R. 2341 1
List of individuals who submitted communications in opposition to H. R.
2341 490
List"of State dental associations, by States, in opposition to H. R. 2341 _. 489
List "of State health departments, by States, in opposition to H. R. 2341. _ 488
Report of —
Army Department 4
Bureau of the Budget 5
District of Cohnnbia Board of Commissioners 1
Health, Education, and Welfare Department 5
Interior Department 2
Post Office Department 5
Statement of —
j^Adams, Mrs. Vera E., president, National Conamittee Against Fluori-
dation, Inc 151
Armstrong, Dr. Wallace D., Medical School, University of Minne-
sota 306
^ Betts, Dr. Charles T., Toledo, Ohio 86, 221
Birmingham, Florence, president, Massachusetts Women's Political
Club 45
Brusch, Dr. Charles A., director, Cambridge Medical Center, Boston,
Mass 141
Dean, Dr. H. Trendley, secretary, council on dental research, Ameri-
can Dental Association 273
Doty, Dr. J. Roy, secretary, council on dental therapeutics, American
Dental Association 289
Exner, Dr. Frederick B., fellow of the American College of Radiology,
University of Washington 62
Ford, Hon. Gerald R., Jr., a Representative in Congress from the
State of Michigan 8
Franzen, Mrs. Hugo, San Francisco, Calif 95
Gale, Dr. E. Harold, chairman, council on legislation, American
Dental Association 255
Garvey, Francis J., secretary, council on legislation, American Dental
Association 24 5
Ginns, Dr. Max, senior dental consultant, Worcester City Hospital,
Worcester, Mass 190
Harris, William Leslie, superintendent, water department. Grand
Rapids, Mich 329
Hey roth, Dr. Francis F., associate professor of industrial toxicology
and assistant director, Kettering laboratory, department of pre-
ventive medicine and industrial health. College of Medicine,
University of Cinciimati 310
Hobson, Maj. Robert W., Dental Corps, Research and Development
Division, Office of the Surgeon General 403
Hunt, Hon. Lester C, a United States Senator from the State of
Wyoming I37
Jordan, Harry E., secretary and chief executive officer, American
Water Works Association (delivered by David Auld, director) 409
Kleinfeld, Vincent A., attorney, Washington, D. C 36
Knutson, Dr. John W., Chief dental officer, Public Health Service 362
Leone, Dr. Nicholas C, Chief, Medical Investigations, National
Institute of Dental Research 362
ni
IV CONTENTS
Statement of — Continued Pa««
Long, Hon. George S., a Representative in Congress from the State of
Louisiana 121
Manning, Dr. Paul, dentist, Springfield, Mass 198
Palmer, Claude N., member, board of directors, National Committee
Against Fluoridation 16
Paluev, K. K., research and development engineer, Pittsfield, Mass-_ 173
Porterfield, Dr. John D., vice president, Association of State and
Territorial Health Officers 405
Robinson, Mrs. Aileen S., Seattle, Wash 177
Schmidt, Mrs. Peder P., Minneapolis, Minn 165
Spira, Dr. Leo, New York, N. Y 185
Swift, Mrs. Harmon, associate editor, Social Spectator, New York,
N. Y 221
Van DeVere, Lillian, president, Citizens' Committee Against Fluorida-
tion, and Connecticut Pure Water Association 108
Watt, James, manager, Washington office, Christian Science Com-
mittee on Publication 58
Welsh, George W., city manager. Grand Rapids, Mich 336
Wier, Hon. Roy W., a Representative in Congress from the State of
Minnesota 6
Zipkin, Dr. Isadore, senior scientist, National Institute of Dental
Research 362
Additional information submitted for the record by —
Adams, Mrs. Vera E., some objections to fluoridation 164.
American Dental Association:
American Cancer Society, letter from Dr. Charles S. Cameron. _ 258
Chapman et al. v. City of Shreveport, brief 252
Interassociation Committee on Health, statement of 259
Letter from Francis J. Garvey, secretary, council on legislation. _ 448
McFarlane and Hoffman v. Mayor and City Council of Baltimore
City, brief '- 24.6
Pohcy of 259
Status of fluoridation in the United States, its Territories and
possessions. May 14, 1954 261
American Medical Association, letter from Dr. George F. Lull,
secretary and general manager 459
Black, A. P., head, department of chemistry, University of Florida,
letter from 461
Brett, Dr. George J., a comparative study of dentistry in natural
fluoridation and nonfluoridation areas 240
Brusch, Dr. Charles A., effect of fluorides on the human body 147
California State Board of Public Health, letter from Dr. Charles E.
Smith, president 4 85
California State Department of Public Health, letter from Dr. Malcolm
H. Merrill, director 485
Carpenter, Dr. C. H., letter from, transmitting other material 320
Central District Dental Society, Little Rock, Ark.:
Letter from Dr. R. L. Smith, Jr., secretary-treasurer 328
Resolution of 328
Citizens' Committee Against Fluoridation, resolution of 115
Citizens Medical Reference Bureau, Inc., letter from Pierrepont E.
Twitchell, president 239
Congress of Industrial Organizations, letter from Katharine Pollak
Ellickson, executive secretary, social-security committee 4 60
Connecticut Pure Water Association, resolution of 115
Crane, Mrs. Robert H., letter from 244
Deubel, Charles C, Jr., letter from 233
Dummett, Dr. Clifton O., letter from, transmitting articles 413
Fanale, Dr. S. J., letter from 484
Ferguson, Anna M., letter from 240
Gould, Dr. A. R., letter from 243
Grand Rapids (Mich.) Chamber of Commerce, letter from Alex T.
McFayden, executive secretary 9
Harris, William Leslie: Fluoride application, Grand Rapids, Mich.,
January 1954, table. 333
CONTENTS V
Additional information submitted for tlie record by — Continued Pase
Health, Education, and Welfare Department:
Biography of —
Knutson, John William 392
Leone, Nicholas Charles 392
Zipkin, Izadore 392
Communities using fluoridated water, 1945-53, chart 377
Deaths from (charts) —
Cancer, United States, Grand Rapids, and Muskegon,
1943-50 375
Five causes in fluoride and nonfluoride cities, 1949-50 374
Heart disease, United States, Grand Rapids, and Muskegon,
1943-50 376
Intracranial lesions. United States, Grand Rapids, and
Muskegon, 1943-50 376
Nephritis, United States, Grand Rapids, and Muskegon,
1943-50 375
Decayed, missing, and filled teeth per adult, fluoride and non-
fluoride communities, chart 365
Decayed, missing, and filled teeth per child (charts) —
Fluoride and nonfluoride communities 363
Nine years after fluoridation (Grand Rapids, Mich.) 364
Distribution of bone fracture experience (charts) —
Number per 100 boys 381
Number per 100 men 381
Estimated fluorine ingested in food and in drinking water contain-
ing 1 part per million fluorine, table 380
Fluorine content of urine in relation to fluorine in drinking water
in (charts) —
Grand Rapids, Mich 384
Montgomery County, Md 383
Fluorine reported in dry substance of food, table 380
Fluorine reported in food as consumed, table 380
Incidence of abnormal clinical findings, 1943-53, table 386
Mean carpal ossification ratio, chart 382
Missing teeth per adult, fluoride and nonfluoride communities,
ciiart 365
Percent fluorine in ash, charts 38-^, 385
Prevalence of abnormal laboratory and dental findings, 1943 and
1953, table 386
Rate of longitudinal growth at proximal and distal end of tibial
diaphysis, chart 385
Towns using naturally fluoridated water, chart 366
Hodge, Harold C, professor of pharmacolog}' and toxicology. Uni-
versity of Rochester, letter from 4 70
Hoffman, Hon. Richard W., letter from 387
MacVriiiimie, Dr. Arthur B., letter from, transmitting statement 222
Maxcy, Dr. Kenneth M., professor of epidemiology, the Johns Hop-
kins University, letter from 462
McCormack, Hon. John W., letter from, transmitting telegram from
a number of doctors 412
McQueen, Mrs. Josephine, statement of 224
Mick, Dr. Robert J. H., letter from, transmitting information against
fluoridation 124
Nassau County (N. Y.) Medical Society, telegram from Dr. Joseph G.
Zimring, chairman, legislation committee 360
New Jersey State Dental Society, letter from Dr. Francis Lehr, chair-
man council on fluoridation 432
New Jersey State Department of Health:
Bacon, John E., statement of 438
Ludlam, Dr. Earl G., chief, Bureau of Dental Health, letter from. 433
Wisan, Dr. J. M., statements of 434, 440
New York State Dental Society, letter. from Dr. Charles A. Wilkie,
secretary 361
New York State Society of Dentistry for Children, letter from Dr.
Solomon N. Rosenstein, president 361
VI CONTENTS
Additional information submitted for the record by — Continued Tae«
Parran, Dr. Thomas, letter from, transmitting information 444
Plainfield (N. J.) Dental Society, letter from 455
Prestholdt, H. L., statement of 228
Pure Water Association of America:
Letter from Mrs. Herman J. Kuppers, State chairman, Florida
statewide committee 486
Statement of Anthony J. Romeo, president, New York statewide
committee 24 1
St. Louis Medical Society, report of, reprint from Missouri Medicine,
February 1954 338
Suffolk County (N. Y.) Dental Society, letter from Dr. S. A. Medvin,
secretary 360
Waldbott, Dr. George L., medical evidence against fluoridation of
public water supplies 234
FLUOEIDATION OF WATEE
TUESDAY, MAY 25, 1954
House of Representatives,
Committee on Interstate and Foreign Commerce,
Washington, D. C.
The committee met, pursuant to notice, at 10 a. m., in the committee
room, 1334 New House Office Building, the Honorable Charles A.
Wolverton (chairman) presiding.
(H. R. 2341 and the reports thereon are as follows :)
[H. R. 2341, 83d Cong., 1st sess.]
A BILL To protect the public health from the dangers of fluorination of water
Be it enacted by the Senate and House of Representatives of the United States
of America in Congress assembled, That no agency of the Government of the
United States (including the government of the_District of Columbia, and of
each Territory and passession of the United States), and no agency of any State,
or of any municipality or other political subdivision of a State, shall treat any
public water supply with any fluoride compound, or make any water so treated
available for general use in any hospital, post oflSce, military Installation, or
other installation or institution owned or operated by or on behalf of any such
agency.
govebnment of the district of columbia,
Executive Offices,
Washington 4, D. C, April 29, 195^.
Hon. Charles A. Wolverton,
Chairman, Committee on Interstate and Foreign Commerce,
United States House of Representatives,
Washington, D. C.
My Dear Mb. Wolverton : The Commissioners have for report H. R. 2341,
83d Congress, a bill to protect the public health from the dangers of fluorination
of water.
The bill would prohibit the United States Government, the Government of
the District of Columbia, every State, and every municipality or other political
subdivision of a State, from treating any public-water supply with any fluoride
compound, or from making any water so treated available for general use in
any hospital, post office, military Installation, or other installation or institution
owned or operated by the United States Government, the government of the
District of Columbia, and State, and any municipality or other political subdivi-
sion of a State.
This report is directed to the harm which, in the light of scientific opinion,
would result to the residents of the District of Columbia if the use of sodium
fluoride in the water supply of the District were prohibited. It should particu-
larly be noted that while H. R. 2341 purports to be a bill to protect the public
health from the dangers of fluorination of water, such dangers appear to be
imaginary. The real danger lies in the elimination of flouride from the Dis-
trict's water supply, since it has been estimated by the Director of Public Health
of the District that should such action be taken, after a period of 10 years
there would be 65 percent more caries in the teeth of the children of the District,
and that by the time such children were 40 years of age, 95 percent of them
would have lost the majority of their teeth. The loss to the public would be
2 FLUORIDATION OF WATER
twofold : the cost of increased dental work, and a deterioration of the public
health arising from the increase in defective and missing teeth.
The May 1953 Journal of the American Dental Association discusses the
fluoridation of water in an editorial reading as follows :
"Evidence favoring fluoridation continues to mount.
"Resolutions passed last month by two of dentistry's leading scientific agen-
cies, decisions made by 2 of the country's larger cities and reports presented by
2 different groups of researchers strengthen the already sound position of pro-
ponents of vpater fluoridation. The Council on Dental Research, April 10, after a
reevaluation of evidence, reaffirmed its support of fluoridation as a dental health
measure and commended departments of public health for their scientific con-
tributions to the problem of caries control through fluoridation. The Council
on Dental Health on April 14 restated its support of fluoridation as a safe anti-
cariogenic measure, pointing out that the volume of accumulated scientific data
has established beyond any reasonable doubt both its safety and eflSiciency. Mil-
waukee citizens on April 7 by referendum overwhelmingly approved fluoridation,
and Cincinnati by an 8 to 1 vote of its city council on April 1 decided similarly.
Three researchers from the University of Rochester reported on April 7 that
'if all fluoride in drinking water containing one part per million fluorine were
to be deposited in the skeleton, the situation would be perfectly safe.' And
lastly, a Yale University School of Medicine scientist again scotched the rumor
that fluoridation of water increases the incidence of cancer by reporting to the
International Association for Dental Research, March 20, that tumors trans-
planted into mice developed more slowly if the mice received fluoride. Thus the
scientific evidence mounts monthly in favor of fluoridation, leaving to opponents
of the process only vapid arguments based either on emotionalism or misinfor-
mation."
The Commissioners have been informed that the American Medical Association,
the American Dental Association, the American Public Health Association, the
State and Territorial Health Oflicers Association, the United States Public
Health Service, the National Research Council, and other leading professional
and scientific organizations have fully endorsed controlled water fluoridation
as an outstanding public health measure.
The Commissioners are therefore of the view that the controlled fluoridation
of the water supply of the District of Columbia is of beneflt to the citizens of the
District, and they strongly recommend that the bill not be enacted.
The Commissioners have been advised by the Bureau of the Budget that there
is no objection on the part of that office to submission of this report to the
Congress.
Very sincerely yours,
Samuel Spencee,
President, Board of Commissioners, D. C.
United States Department of the Interior,
Office of the Secret art,
Washinffton 25, D. C, September IS, 1953.
Hon. Charles A. Wolverton,
Chamnan, Committee on Interstate and Foreign Commerce,
House of Representatives, Washington 25, D. C.
My Dear Mr. Wolverton : This is in response to your request for a report from
this Department on H. R. 2341, a bill to protect the public health from the dan-
gers of fluorination of water.
I recommend that the bill be not enacted.
H. R. 2341 would prohibit the treatment of any public water supply with any
fluoride compound by any agency of the United States, including the District of
Columbia and the Territories and possessions of the United States, or by any
agency of any State, including any municipality or other political subdivision
thereof. It would prohibit these agencies also from making available any water
treated with fluorides for general use in any hospital, post office, military installa-
tion, or other installations or institutions owned or operated by or on behalf
of any such agency.
In connection with the operation of a program for prevention and treatment
of dental disease among American Indians, this Department has had occasion
to give considerable study to the effect of fluorine in drinking water. It is the
FLUORIDATION OF WATER 6
opinion of our specialists in this field that the addition of 1.0-1.5 parts per mil-
lion of fluorine to water supplies produces a beneficial effect upon the oral health
of individuals consuming such reconstituted waters. Furthermore, we have
been unable to find any scientific evidence which shows that the ingestion of
water containing 1.0-1.5 parts per million of available fiuorine ions has any
deleterious toxicological effect upon the human body. We are much opposed to
any action which would deprive the American Indian of the health benefits to
be derived from the carefully controlled usage of fluorides in their drinking
water.
Several of the Territories under the jurisdiction of this Department are con-
sidering fluorinating their water supplies, and some have begun the process.
The Alaska Board of Health has recognized the benefits of fluorinating drinking
water, and has established procedures which must be followed by Alaskan com-
munities which choose to utilize this process. At the present time, there are
three communities considering fluorination in Alaska, and completed plans have
been received by the board of health for the installation of fluorination equip-
ment at Anchorage, which is the largest city in Alaska.
By House Concurrent Resolution No. 64 of the 26th Legislature of the Terri-
tory of Hawaii, the matter of fluorination of the water supply of Honolulu and
Hilo was placed before the board of health of the Territory, the board of water
supply in the city and County of Honolulu, and the board of water supply of
the County of Hawaii, for their study and report back to the legislature. Com-
prehensive compilations of source materials, flndiugs, and conclusions have been
prepared by these boards, and have been submitted to the Legislature of Hawaii
for consideration.
In the Virgin Islands, fluorination of water supplies is in the planning stage.
At present no fluoride compounds are added to the public or semipublic water
supplies in that territory. American Samoa has done nothing about the fluorina-
tion of its water supplies, but plans to give the matter consideration because
of the high percentage of tooth decay among Samoan children.
The Commonwealth of Puerto Rico has taken steps toward the fluorination
of its water supply, based on the evidence contained in various scientific litera-
ture, and especially on the i-esolutiou approved by the Association of State and
Territorial Health Officers at its annual meeting held in December 1952. By
Act No. 376 of 1952, the Puerto Rican Legislature appropriated to the aqueduct
and sewer authority the sum of $96,000 for the purchase of equipment and ma-
terials necessary for the fluorination of the water serviced by the metropolitan
aqueduct system. An appropriation in the sum of $165,000 is being requested
from the legislature this year for the purchase of equipment and supplies for
the fluorination of water in other public water systems. The 6-year economic
plan for 1953-54 to 1958-59 calls for appropriations in the sums of $145,000,
$169,000, $195,000, $222,000, and $183,000 in successive years for the purchase
of equipment and materials for broadening the fluorination program. It is
expected that by the year 1958-59, all major public water systems in Puerto
Rico will be supplying fluorinated water to consumers.
In the administration of the Territories of the United States, a steady policy
has been followed of placing the responsibilities of local self-government in the
control of the territorial peoples as their political, economic, and social devel-
opment has warranted. The beneficial result of this policy has been recognized
generally. Enactment of H. R. 2341 would be a reversal of this beneficial policy
as far as local public health is concerned. All of the Territories have the human
resources with the accumulated wisdom, intelligence, and judgment sufficient
to enable them to determine matters of local public health. We believe this
opinion is substantiated by the manner in which the several Territories are now
studying the matter of fluorinating their water supply.
It would appear also that to the extent H. R. 2341 purports to control State
action concerning local health matters it would be subject to constitutional
objections. Such objections are not, of course, within the purview of this
Department.
Therefore, I recommend that H. R. 2341 be not enacted.
The Bureau of the Budget has advised that there is no objection to the sub-
mission of this report to your committee.
Sincerely yours,
Okme Lewis,
Acting Secretary of the Interior.
4 FLUORIDATION OF WATER
DEPARTMENT OF THE AbMT,
Washington, D. C, May 13, 1953.
Hou. Charles A. Wolvb:eton,
Chairman, Committee on Interstate and Foreign Commerce,
House of Representatives.
Dear Mr. Chairman : Reference is made to your request to the Secretary of
Defense for the views of the Department of Defense with respect to H. R,
2341, 83d Congress, a bill to protect the public health from the dangers of
fluorination of water. The Secretary of Defense has delegated to the Depart-
ment of the Army the responsibility for expressing the views of the Department
of Defense thereon.
The Department of the Army, on behalf of the Department of Defense, is
opposed to the enactment of H. R. 2341 for the reasons set forth below.
The bill, H. R. 2841, would prohibit all agencies of the Government of the
United States, and all agencies of any State or municipality or other political
subdivision of a State, from treating any public water supply with any fluoride
compound. Further, it would prohibit the use of such treated water by any
hospital, post oflSce, military installation, or other installation or institution
owned or operated by or on behalf of any of the aforesaid agencies.
The principle of fluorination of certain potable water supplies as a means of
preventing dental caries in children has been accepted by the house of delegates
of the American Dental Association (October 1950), by the governing council
of the American Public Health Association (November 1950), by the Surgeon
General, Department of the Army (November 1950), by the American Medical
Association (December 1951), by the United States Public Health Service, and
by other Federal and State agencies interested in public health.
In April 1951, the National Research Council convened an Ad Hoc Committee
on Fluorination of Water Supplies to review the evidence on this subject and to
prepare an impartial report. Special attention is invited to the conclusions of
the report which state in part : "In view of these considerations, the committee
recommends that any community which includes a child population of suflicient
size, and which obtains its water supply from sources which are free from or
are extremely low in fluorides, should con.sider the practicability and economic
feasibility of adjusting the concentration to optimal levels. This adjustment
should be in accord with climatic factors and a constant chemical control
should be maintained. With proper safeguards, this procedure appears to be
harmless."
Present medical service policy is against the fluorination of water supplies on
military posts because the number of children on a military post is usually very
small as compared with the adult population. However, as the controlled
studies on this subject are continued, there is increasing evidence that older
populations may also benefit from this practice. If this point is proved, then
it will be desirable for the Army to fluorinate water at posts where the water
is deficient in this chemical.
It is the opinion of this Department that, under certain conditions, the
fluorination of water .supplies is a public health asset and that legislation
which would prohibit this practice would be detrimental to the public interests.
In thi.s connection, it is to be noted that fluorination of public water supplies
has been accomplished in 703 communities with an estimated population of
16,500,000, and that scientific studies in these areas indicate that great benefits
in the reduction of dental caries have been derived from the fluorination of
water.
For the foregoing reasons, the Department of the Army, on behalf of the
Department of Defense, recommends that H. R. 2341 be not favorably con-
sidered.
The Department of the Army is unable to estimate the fiscal effects of the
proposed bill.
This report has been coordinated among the departments and boards of the
Department of Defense in accordance with procedures prescribed by the
Secretary of Defense.
The Bureau of the Budget has been consulted and advises that there is no
objection to the submission of this report to the Congress.
Sincerely yours,
Robert T. Stex-ens,
Secretary of the Army.
FLUORIDATION OF WATER 5
Office of the Postmaster General,
Washington 25, D. C, May 13, 1953.
Hon. Charles A. Wolverton,
Chairman, Committee on Interstate and Foreign Cammerce,
House of Representatives, Washington, D. G.
DEii.R Mr. Chairman : Reference is made to your request for a report on H, B.
2341, a bill to protect the public health from the dangers of fluorination of water.
The Department does not treat drinking water with fluoride and so far as it
is aware it does not make water so treated available to the public.
This I>epartment is not in a position to report on this measure because it does
not have the requisite technical knowledge necessary to formulate an opinion
concerning the propriety of treating drinking water with fluoride.
The Bureau of the Budget has advised that there would be no objection to the
submission of this report to the committee.
Sincerely yours,
C. R. Hook, Jr.,
Deputy Postmaster General.
Department of Health, Education, and Welfare,
Washington, January 20, 1954.
Hon. Charles A. Wolverton,
Chairman, Committee on Interstate and Foreign Commerce,
House of Representatives, Washington 25, D. C.
Dear Mr. Chairman : This letter is in response to your request of February 4,
1953, for a report on H. R. 2341, a bill to protect the public health from the dangers
of fluorination of water.
The l)ill would categorically prohibit F'ederal, State, or local governmental
agencies from treating public water supplies with any fluoride compound and
from making water so treated available for use by or on behalf of any such agency.
No provision is made with regard to the enforcement of these prohibitions.
After some years of careful study and observation, including a review of many
independent investigations, the Public Health Service of this Department arrived
at the conclusion that the adjustment of the fluoride content of public water
supplies is a safe, effective, and economical procedure for the partial prevention
of tooth decay. The Service is continuing? with its own research, with research
carried on by grants to independent groups, and in its observation of separate
studies being made by others in order to leave no stone unturned in its vigilance
to protect the public health and safety of the people of this country.
It is the view of this Department that the decision on whether to fluoridate
public water supplies should continue to rest with the local communities. We
believe that they are entirely competent to make such decisions and that Federal
intervention, either to require or to prohibit fluoridation, would not be justiflable.
We therefore recommend that H. R. 2341 not be enacted by tJie Congress.
The Bureau of the Budget advises that it perceives no objection to the submis-
sion of this report to your committee.
Sincerely yours,
Oveta Gulp Hobby,
Secretary.
Executive Office of The Peesident,
Bureau of The Budget,
Washington 25 D. C, May 7, 1954.
Hon. Charles A. Wolverton,
(Chairman, Committee on Interstate and Foreign Commerce,
House of Representatives, Washington 25 D. C.
My Dear Mr. Chairman : This will acknowledge your letter of April 20, 1954,
requesting the views of the Bureau of the Budget on H. R. 2341, a bill to protect
the public health from the dangers of fluorination of water.
Tliis bill would make it illegal for Federal, State, or local agencies to treat
public water supplies with any fluoride compound and to distribute such water
for use by the public.
The treatment of water with fluorides has been given extensive study by the
Public Health Service and many independent agencies. As a result of these
studies the conclusion has been reached that the proper amount of fluoridation
6' FLUORIDATION OF WATER
of public water supplies is a safe, effective, and economical means for the partial
prevention of tooth decay. The principle of fluoridation of potable water sup-
plies as a means of preventing dental caries was endorsed by the house of dele-
gates of the American Dental Association in October 1950, by the governing
council of the American Public Health Association in October 1950, by tne
Surgeon General, Public Health Service in April 1951, and by the American
Medical Association in December 1951.
Furthermore, the actual adoption of the practice of water fluoridation is, of
course, a matter for decision by the local community and should remain so. It
is believed that the States are quite competent to make such a decision without
Federal intervention.
For these reasons, the Bureau of the Budget recommends against the enact-
ment of H. R. 2341.
Sincerely yours,
Donald R. Belcher,
Assistant Director
The Chairman. We are beginning hearings this morning on H. R.
2341, a bill which would prohibit the United States Government, the
government of the District of Columbia, every State, and every mu-
nicipality, or other political subdivision of a State, from treating any
public water supply with any fluoride compound, or from making
any water so treated available for general use in any hospital, post
office, military installation, or other installation or institution owned
or operated by the United States Government, the government of the
District of Columbia, and State, and any municipality or other politi-
cal subdivision of a State.
The first witness this morning will be the Honorable Roy W. Wier,
a Member of Congress from Minnesota who introduced the bill by
request.
STATEMENT OF HON. EOY W. WIER, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF MINNESOTA
Mr. Wier. Mr. Chairman and members of the committee, as the
sponsor of this bill, which was introduced a little over a year ago, my
role here this morning and my participation will be very limited,
because I know that there are 2 or 3 scheduled to be heard this morn-
ing who are very anxious to be heard so that they may get away to
attend to other tasks. I am a layman in this field, but the introduc-
tion of this bill has been of great interest and concern to me. This is a
very controversial bill. I want to assure the committtee of that.
During my 6 years here, Mr. Chairman, I have received more mail
and communications and material for the bill now before you than on
any other subject or issue pending in the Congress during those 6
years. I was tempted this morning to bring over the file of communi-
cations that I have received from all corners of this Nation, from
people of many walks of life, many conscientious and sincere people;
likewise, many people who have spent a long time in the field of
medicine. I have proponents for this bill coming from the medical
profession ; the dental profession ; the chemical profession ; the engi-
neering profession ; and those professions related to this subject. It
is not one-sided by any stretch of the imagination, as I think will be
brought out here during the process of your hearings.
My introduction of this legislation was prompted by a limited num-
ber of people in my own community, and then further impetus was
given to the controversial nature and justification for this bill when
FLUORIDATION OF WATER Y
I came to Washington 2 years ago and met with a number of people
here in the District who have been in this field for some time. I have
been working with a committee in the District of Columbia headed by
a Miss Vera Adams, president, and Mr. Claude Palmer, a member of
the board of directors. The committee is known as the National Com-
mittee Against Fluoridation. They have been advising with me,
giving me considerable information, and lending their support to this
cause.
With all of this information and contacts and my own thinking
through, if I could lend any point in my observations as a result of
my experience in the past year, I would advise the committee that in
my opinion I would feel that the Federal Public Health Service has
got a little overzealous in this field and has gone overboard, because
this is something that is not to be decided within a period of a month
or a year. The results from a long study and research, documented
evidence, will be presented to the committee this morning, and in the
interest of the American people, I would feel that the Federal Govern-
n^ent — and I say Federal Government because here a Federal agency
seems to be the center of the sponsorship of fluoridation, and so my
criticism would be leveled at the lack of caution with which that
agency has moved in this field. I think that will be covered likewise.
Mr. Cliairman, I know Mr. Ford has to get to Jacksonville, Fla., as
soon as he can, and I do not want to take too much time, because you
have a long list of very capable and very professional people here.
I want to take this occasion, Mr. Chairman, to thank you and the
members of the committee, for affording these thousands and thou-
sands of people in the United States an opportunity to be heard and
to offer to your committee and the Congress their views, their reactions,
and their findings on this most important question of the health of the
American people.
With that I will close. I will go to my own committee now on the
physically handicapped, and again thank you in behalf of all these
thousands of people.
Before I leave I want to introduce to you the sponsors of this meet-
ing who will take over, and from the proponents' side they have given
you a list of the sj)eakers that have been invited to appear here, both
as to who they are and as to the position in which they will speak. We
would like the proponents to have the first half of the time.
The Chairman. We shall have to determine our procedure. It is
our intention to hear the proponents this morning. We may hear
some of them this afternoon. We want to make certain that both
sides have an opportunity to be heard. We do not know what the
situation will be with respect to the House floor, and for that reason
I want to make certain that the people who have come a long distance
will have an opportunity to be heard,
Mr. WiER. Tliat is right, and they paid their own way.
I want to introduce the people who will manage the proponents' side
of this legislation.
First, there is Miss Vera Adams, representing the .National Com-
mittee Against Fluoridation. !
Then there is Mr. Claude Palmer, one of the membeirs of the board
of directors of the District of Columbia Committee Against Fluorida-
tion, who will rather bear the burden of the management of the pro-
ponents of this legislation before the committee.
8 FLUORIDATION OF WATER
The Chairman. We thank you, Mr. Wier, for appearing here and
for the time you have taken in preparing the list of witnesses you have
submitted to us.
In order to accommodate our colleague, Mr. Ford, who speaks in
opposition, we will hear him at this time.
STATEMENT OF HON. GERALD R. FORD, JR., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF MICHIGAN
Mr. Ford. Mr. Chairman and members of the committee, initially
let me express my appreciation for the opportunity to present my point
of view at this time. It is a very great accommodation for me and I
appreciate it.
Mr. Chairman, I represent the Fifth Congressional District in
Michigan, which includes the city of Grand Kapids, a community of
176,000 people, and the city of Grand Haven, Mich., a community of
approximately 8,000 people, both of which do have fluoridation at
the present time.
Grand Rapids, I believe, was in the forefront in this program.
According to information provided me, the community has used
fluoridation since January 1, 1945. The city of Grand Haven has
used fluoridation since October 1952.
Another community in my district is Holland, Mich., and although
they have not used a similar program to those that exist in Grand
Rapids and Grand Haven, they do have some variation of the utiliza-
tion of fluoridation.
I am testifying this morning because in my congressional district,
and in particular the communities that I mentioned, there is a very,
very strong feeling that we in those communities should have the right
to decide for ourselves whether or not we, as a community, should use
fluoridation. The program, in our estimation, has been successful in
the communities which have used it. There has been in the past 9
years considerable testing conducted in the city of Grand Rapids as a
result of this fluoridation program. I have a number of documents
here which indicate the alleged success of this program, and I would
like to give you some of the alleged results of fluoridation in the city
of Grand Rapids.
I am now quoting from a paper by Francis A. Arnold, Jr., D. D. S.,
and Trendley Dean, D. D. S., and John W. Knutson, D. D. S.,
D. P. H., on the Effect of Fuoridated Public Water Supplies on Dental
Caries Prevalence. It is a 7-year study of the situation in Grand
Rapids, Mich., which, as I indicated, does have fluoridation, compar-
ing it to Muskegon, Mich., a community which does not have fluorida-
tion. The summary from this paper is as follows, and I will quote
from it :
The methodology and results after 7 years of the Grand Rapids-Muskegon
study have been described. The 1951 results on continuous resident children
after 614 years of fluoridation of the Grand Rapids water supply indicate :
1. There has been a reduction in dental caries rates in permanent teeth of
Grand Rapids children ranging from 66.6 percent in 6-year-old children to 18.1
percent in the 16-year age group. Similar results have been obtained regarding
the deciduous teeth.
2. Similar reductions have not been observed in Muskegon where the water
.s<ipply remained "fluoride fi-ee" until the last 3 months of this study i)eriod.
FLUORIDATION OF WATER 9
3. This change in dental caries rates at Grand Rapids was also reflected in
observations based on objective assessment, that is, a reduction in the number
of missing teeth.
4. A comparison of the 1951 caries rates in Grand Rapids vpith those of Aurora,
111., shows that, insofar as can be determined to date, the use of a fluoridated
water gives the same beneflcial effects as does the use of a natural fluoride
water of similar concentration.
The mention of the city of Aurora, 111., I think hits the nub of our
objection to this legislation. The city of Aurora, 111., through natural
causes, has a certain amount of fluorine in the water they use in that
community. We in the city of Grand Rapids and in Grand Haven,
by local action, decided that we wanted to have the same advantage
that the people in the city of Aurora, 111., have for our own health.
As I understand, this bill, if approved as is, would prevent us, a local
community of Michigan, from doing what we want to do ourselves for
our own health's sake, based on whatever judgment we as local citizens
deem necessary.
It is almost incomprehensible to me that a local community would be
precluded from making a decision of this sort itself if it, as a com-
munity, believes there would be certain advantages from such a pro-
gram. I think that is the nub of the question.
I have a number of communications from reputable dentists in my
community. I would not fill the record with those unless the chairman
so desires. I do have, however, a communication from the Grand
Rapids Chamber of Commerce which I would like to insert in the
record without objection. (Other communications will be filed with
the committee.)
The Chairman. You have that privilege. As to the other com-
munications to which you referred, we have received a great many
letters, telegrams, and petitions, both for and against this proposed
legislation, and it would be impossible to give recognition to all of
them in the record, but in order to present the views of your consti-
tuents, I think you might make reference to them.
Mr. Ford. Thank you very much.
(The letter referred to is as follows :)
Grand Rapids Chamber of Commerce,
Cfrand Rapids, Mich., May 22, 1954.
Subject : H. R. 2341, fluoridation of water supplies.
Hon. Gerald R. Ford, Jr.,
United States House of Represetitatives,
Washington, D. C.
Dear Congressman Ford : The Grand Rapids Chamber of Commerce is opposed
to the passage of H. R. 2341 which would prohibit fluoridation of drinking water.
We believe the author of the bill must have based his bill on much of the same
erroneous interpretation of records and unfounded accusations of which this
organization has many examples in regard to Grand Rapids.
We urge the fullest investigation and opportunity for presentation of evidence
in favor of fluoridation and refuting unwarranted, unfounded, and malicious and
false reports of adverse effects. The later have included, falsely, increased
juvenile delinquency, moral degeneration, heart, brain, respiratory, and circula-
tory disorders and deaths, and other dreanied-up and trumped-up charges, all of
which are disputed by the records. Even abortions were alleged to have in-
creased, which is similarly belied by the records.
There seems to be a mass hysteria about the subject which should be dispelled
along with the religious and other prejudices in regard to the subject.
Michigan and Grand Rapids have a tremendous industrial as well as health
stake in this matter.
10 FLUORIDATION OF WATER
No action should be taken on this bill until the fullest hearings have been held
and the facts have publicly demonstrated that this bill should not pass.
Sincerely,
Alex T. McFadyen,
Executive Secretary.
Mr. Ford. There is one point that may conceivably be raised subse-
quently in this record. The assertion has been made that the vital
statistics of Grand Eapids, Mich., show an increased number of deaths
from heart disease, intracranial lesions, and nephritis since the pro-
gram of fluoridation was initiated.
The facts on this particular phase of the controversy are as follows :
This statement presents an erroneous implication because it is based on a
comparison of 1944 data for the city of Grand Rapids —
which, incidentally, was before the fluoridation program began—
with 1948 data for the whole of Kent County in which Grand Rapids is situated.
Reliable population data for this area are available from official agencies in
Grand Rapids and in the State of Michigan and are based on an intimate knowl-
edge of shifts of population in and out of the city.
Actually, changes in the death rates in Grand Rapids have not been significantly
different than for the country as a whole. A claimed increase in the number of
deaths from heart disease in 1949 is not a fact but is due to a 1949 revision
in the classification in recording deaths.
I think that particular statement is important for the record because
I have heard on the floor of the House allegations made that the
statistics in Grand Rapids and Kent County prove beyond a question
of a doubt that fluoridation resulted in an increased death rate in
certain areas.
In closing my statement I would like to reemphasize that our objec-
tion to this legislation is that the Federal Government should dictate
to us what we as communities can do. If this legislation is enacted
as it is, it would preclude us, a community in the United States, from
deciding whether or not we want to derive the same benefits that a city
like Aurora, 111., has where they have flourine in their water from
natural causes. It should be up to us, a community of 176,000, to
make the decision as to whether or not we want to implement our
water supplies so that we can get whatever benefits now accrue from
natural causes.
I shall be very glad to answer any questions.
The Chairman. Any questions? Mr. Heselton.
Mr. Heselton. I am sorry I could not be here during all of your
statement. Did you indicate when Grand Rapids adopted fluori-
dation?
Mr. Ford. Grand Rapids started using fluorine in its water supply
on January 1, 1945.
Mr. Heselton. Was that as a result of vote of the city council or
the community as a whole ?
Mr. Ford. The decision was made by the governing fathers of tlie
community. No effort was made in Grand Rapids to stir up a problem
with the electorate. It was purely an administrative decision based
on factual data presented to the proper city authorities. We have
had no trouble whatsoever in that community as a result of this pro-
gram being initiated.
Mr. Heselton. Thank you.
The Chairman. Any further questions ? Mr. Priest.
FLUORIDATION OF WATER H
Mr. Priest. Mr. Ford, I have approached this legislation with an
open mind in an eif ort to get all the information I can on both sides of
the question. I will be particularly interested in the scientific testi-
mony that is to be presented here. You take a position that is inlier-
ently a position I usually take, that is, that your community of 175,000,
which is about the same size as my community, should have the right
to make such a decision without Federal intervention. I could easily
see how perhaps a strange interpretation might bring the Federal Gov-
ernment into the held, particularly with reference to water supply for
our Federal installations within a city. Other than that, and with the
possible exception of a project that might be sponsored by a local public
health service cooperating with the Federal Public Health Service, it
is difficult for me to see a constitutional basis for Federal Government
action in a situation of this sort. Have you given some thought to that
phase of it i
Mr. Ford. Mr. Priest, frankly, I have not had an opportunity to
thoroughly investigate the constitutionality of this legislation. I
would, from my experiences as a lawyer, say there might justifiably
be a serious question as to the constitutionality of this proposal. I
would, however, leave that up to those who are constitutional lawyers
by experience. My prime objection, as I have indicated earlier, is the
attempt by the Federal Government to tell the people in our Nation
who are mature and who 1 think are as wise as some of the Federal
fathers, what they can or cannot do. I would certainly object to any
legislation that would extend the omnipotence of the Federal Govern-
ment.
Mr. Priest. It is largely a question of philosophy rather than con-
stitutionality or legality, and 1 must say 1 share that feeling with you
in general. I think we do better with a minimum of Federal Govern-
ment direction rather than a maximum.
Mr. Ford. I might say that it would be most unjustifiable for any-
one to allege that responsible city officials in any community would
seek to undertake a program that would be harmful and detrimental
to the health of the people in that community.
Mr. Priest. We have in my own State, although not in the district
I represent, a situation similar to what you described in the town of
Pulaski, Tenn., the county seat of Giles County, a town of about 6,000
population. The water supply of that town has a natural content of
lluorine. I have received some very interesting statistics which I hope
to put in the record with reference to a comparison of vital statistics
in that town with other nearby towns that do not have that natural
supply and have not added any artificial supply. As I expressed to
you in the beginning, I am approaching this legislation with an open
mind because 1 have received such positive statements on both sides
of the question.
That is all, Mr. Chairman.
The Chairman. Any further questions ? Mr. Springer.
Mr. Springer. May I ask my colleague if he is a lawyer *
Mr. Ford. Yes, I am.
Mr. Springer. I am wondering under what section of the Constitu-
tion the proponents are justifying this proposed legislation ?
Mr. Ford. I suppose the general welfare provision of the Federal
Constitution. Frankly, I have not gone into the constitutionality of
48391—54 2
12 FLUORIDATION OF WATER
this proposed legislation. My firm objection rests on different
gi'ounds.
Mr. Springer. There is no doubt that anything that has to do with
health is under this committee. The point I am trying to find out is
just how you would regulate health. I believe I will yield back, Mr.
Chairman, until I look into this further.
The Chairman. Any further questions? Mr. Harris.
Mr. Harris. Mr. Ford, is not the basic philosophy behind this legis-
lation that those who propose to use fluorine for this purpose need to
be protected from their own misgivings as to what this w^ill do?
Mr. Ford. I think that is true, but let us see if we could carry that
philosophy to the ultimate extreme.
Mr. Harris. In other words, is not the basic philosophy behind
those who are sponsoring this type of legislation, that even if the
people of Grand Rapids, Mich., might decide themselves that they
want to use it, they do not know what is best for them and the pro-
ponents of the legislation know what is best for them and want to
protect them from their own ill-advised feeling?
Mr. Ford. I think that quite definitely is the philosophy of tlie
legislation. May I say that if you cari-y that philosophy to the ex-
treme, however, and if you want to be perfectly honest, you have to
add certain words to the legislation. The bill should say that com-
munities shall not be able to treat any public water supply with any
fluoride compound, and you must add to that that any community
must remove from its water supply any natural fluorines which al-
ready exist. Otherwise you are being completely inconsistent. If
a community that has fluorine in its water naturally is permited to go
along and use that water supply, it is doing something harmful and
deleterious to the public just as much as any community that adds
fluorine to its water supply. So I think to be perfectly fair and honest
if people believe in this philosophy they should also seek to remove as
well as prevent the addition of fluorine.
Mr. Harris. Do you know whether or not there is a religious back-
ground attached to this proposal ?
Mr. Ford. Not that I know of.
The Chairman. Any further questions? Mr, Pelly.
Mr. Pelly. Regardless of the merits or demerits on a scientific
basis, have you had occasion to observe the tendency in our Public
Health Service to accomplish by policy and regulation objectives
which are beyond their scope ?
Mr. Ford. Mr. Pelly, I am not qualified to answer that question.
All I know is that in the communities in my district which use this
program, I think it was more or less locally sponsored. I know it has
been carried on under the supervision of the local public health au-
thorities. I also know that certain observers have come in from the
Federal Public Health Service to make checks as to the success or
failure of the progi-am, but we instituted the program, we have car-
ried it out, and we like it, and we would not like the Feleral (xovern-
ment telling us that we should not have it.
Mr. Pelly. Do you think it is right that the Public Health Service
should stimulate, encourage, and do everything they can to promote
local fluoridation as a matter of departmental policy without its being
within the realm of the desire of the Congress ?
FLUORIDATION OF WATER 13
Mr. Ford. I do not think the Public Health Service or any other
agency should be a propagandizing agency for any pet project that
they have, but I think they have a responsibility to make what scien-
tific data that they have available, available for communities which
e:j:press an interest.
Mr. Pelly. Here is a program that is very controversial and on
which scientists themselves seem to disagree, and it seems to me that
the Public Health Service has taken upon itself to decide that it is
scientifically justifiable and they have actually carried on a program
of propaganda. I myself have no knowledge or basis for saying
whether the program is good or bad, but I do object to the departments
of Government accomplishing by regulation what is not the intent
of the law.
Mr. Ford. I certainly concur in that general observation, but from
my own experience and observation in my own community I doubt
if anybody but the local people decided that they wanted the pro-
gram. We decided it; we like it; and we certainly object to Uncle
Sam telling us we cannot do it unless he wants to tell the communities
that have natural fluorine they cannot use it either.
Mr. Pelly. We had some legislation recently dealing with the
grants-in-aid program, and we were told if the Public Health Service
desired to do so, with the Surgeon General's approval, they could take
the grants-in-aid funds and finance fluoridation in a community. It
seemed to me that was going pretty far.
Mr. Priest. Will the gentleman yield ? I believe it had to be with
the approval of the local community. They could not go ahead with-
out the approval and cooperation of the local community.
Mr. Pelly. I would say they would not necessarily have required
local approval but would have been financing a research program
which would not require local approval or State approval.
Mr. Priest. It seemed to me that even in the beginning it required
the cooperation and approval of the local community or the State, or
whatever subdivision of government was involved.
Mr. Pelly. I would certainly defer to my distinguished colleague
on health legislation, because he has had great experience in that.
The Chairman. Any further questions? Mr. Younger.
Mr. Younger. Mr. Ford, it is your idea, I gather, that you believe
u local problem should be settled locally. Do you also believe it
would be wise to have a local vote on the subject ?
Mr. Ford. I think there should be a local vote if the local com-
munity thinks that is proper. If a local community does not want a
vote, I do not think the Federal Government should impose its will
in that regard either. I think that would be definitely beyond the
authority of the Federal Government.
Mr. Younger. There is no legislation that you know of about put-
ting chlorine in water, is there ?
Mr. Ford. I am not familiar with that.
Mr. Younger. That is all.
The Chairman. Any further questions ?
Mr. Bennett. Have you given any thought to the question of
whether the Public Health Service should be restricted in its activities
in selling the idea of fluoridated water to States and localities? It
has come to my attention that the Public Health Service over the
14 FLUORIDATION OF WATER
past few years has devoted considerable time to sending people around
to States and localities in order to sell them on the advisability of
fluoridating their water. I am inclined toward your view that the
matter should be within the discretion of the local community, but
I am wondering if it might not be advisable to give consideration .to
whether the United States Public Health Service should be limited
in its activities to sell this program and to try to convince commu-
nities that are otherwise not interested that they should have it. In
other words, should the United States Public Health Service be
restricted in spending public money to go out and try to sell the
program ?
Mr. Ford. Mr. Bennett, I personally feel about the activities of
the Public Health Service in this field as I strongly felt about the
public-housing people going out in local communities and trying to
impose upon local communities low-rent public housing. I violently
opposed that, and I suspect I would oppose any propaganda program
by the Public Health Service in this field. Let me say I am not
qualified to say whether or not fluoridation is successful except from
what information is given to me. I am not a doctor or a scientist.
But the proper officials in the communities I mentioned, who are
technicians, do believe there are benefits from the program and they
have convinced the govening fathers that it should be used. I do
not believe the Public Health Service initiated the action the commu-
nities have taken. In the case of Grand Haven, I suspect that because
of the success of the program in Grand Rapids, they followed suit
some years later.
Mr. Bennett. I am perfectly willing to leave the matter up to
the people who are directly concerned. On the other hand, I question
the wisdom of the Federal Government appropriating money for an
agency to try to propagandize in favor of a program. In view of
the controversial nature of the subject and the violent objection that
many people and many communities have, I doubt the wisdom of
having any agency of the Federal Government going out and trying
to sell it.
Mr. Ford. It is pretty hard to try to draw a line of distinction.
Will we get into the same problem as to whether we should adopt
the program of immunization against poliomyelitis ? The local people
should decide whether they want their children inoculated, or what-
ever the term is.
Mr. Bennett. Once you authorize the Federal Government to spend
money to sell a program, you are giving that program the blessing
of the Federal Government and whether it is good or bad or whether
it is desirable in a particular community or not, you are nevertheless
making a Federal program of it.
Mr. Ford. I think this committee probably would be the best vehicle
to determine whether or not the Public Health Service has gone
beyond its proper function.
Mr. Bennett. That is all.
Mr. Heselton. Have you seen the reports from the departments
on this legislation ?
Mr. Ford. No, sir.
FLUORIDATION OF "WATER 15
Mr. Heselton. With reference to the question of constitutionality
raised by Mr. Springer, I would like to quote this sentence from the
report of the Department of the Interior :
It would appear also that to the extent II. R. 2341 purports to control State
action concerning local health matters it would be subject to constitutional
objections.
I thought )'ou might like to have that particular expression in your
presentation.
Also, I thought you would be interested in this quotation from the
report of the Bureau of tlie Budget :
Furthermore, the actual adoption of the practice of water fluoridation is, of
course, a matter for decision by the local community and should remain so.
It is believed that the States are quite competent to make such a decision without
Federal intervention.
So apparently there is no disposition on their part to impose a Fed-
eral decision on the local communities.
Mr. Springer. I have been looking at the Constitution here, and the
only section which has to do with providing for the common defense
and general welfare would be section 8. I see nothing in the Consti-
tution relating to the word "health." I do not think health was con-
sidered when the Constitution was written, and there is no amend-
ment that would bear on this at all. The question that arose in my
mind was, if you can regulate tliis, why could you not regulate every-
thing having to do with public health in any city ? Why not regulate
the size of a hospital in a particular city and how the hospital shall
be conducted if we have this power over health ? That is the point
that has arisen in my own mind. I do ]iot know what the decisions
say. I think whoever wrote the bill tried to get around the consti-
tutionality by these words —
or make any water so treated available for general use in any hospital, post
office, military installation, or other installation or institution owned or operated
by or on behalf of any such agency.
I do not know; they might have some control over a post office or
military installation, altliougli it does appear to me that is stretching
it to an extreme point. This is just a curbstone opinion, but looking
at the Constitution, I do not see anything in the Constitution that
gives power over health.
The Chairman. Any further questions?
We thank you, Mr. Ford, for your appearance here this morning.
We are glad to have your views.
Mr. Ford. Thank you again, Mr. Chairman.
The Chairman. I have a list of witnesses prepared by Mr. Wier
of those interested in this bill, and the order in which those names
have been given to me would seem to indicate it was the intention
to call Mr. Claude Palmer next. Is that right?
Mr. Palmer. That is correct, Mr. Chairman.
The Chairman. Mr. Palmer, if you will give your name and the
position that you occupy and for whom you speak here this morning,
we will be glad to hear your testimony.
16 FLUORIDATION OF WATER
STATEMENT OF CLAUDE N. PALMER, MEMBER, BOARD OF DIREC-
TORS, NATIONAL COMMITTEE AGAINST FLUORIDATION
Mr. Palmer. Thank you, Mr. C'liairman and jientlenieii.
I am Claude N. Palmer. I am a director of the National Committee
Against Fluoridation, which is incorporated under the laws of the
District of Columbia.
I am employed as director of trade relations by a trade association
in the fresh fruit and vegetable business. My appearance here has
nothing to do with my commercial employment. I am appearing here
solely as a member and director of the gi'oup opposed to fluoriclation
in Washington.
Mr. Chairman, with your permission we would like to change the
order of our witnesses and have our counsel, Mr. Vincent Kleinfeld,
follow me if that is agreeable.
The Chairman. I would like to call to your attention, Mr. Palmer,
and others waiting to testify either for or against this bill, that the
tremendous schedule of work that this committee has before it has
required it to fix a limitation of 3 days for the hearings on this bill,
and w^e wish to hear during those 3 days those who are for and against,
so that we would ask each of you to conserve time so that w^e may hear
as many witnesses as possible. Otherwise, it will be necessary to take
the statements of the witneses and make them a part of the record
without their personal appearance. I might say in that connection
we find very frequently witnesses prefer to do that, so that if there are
any witnesses here today for or against this legislation who would like
to present a statement and have it made a part of the record, if they
would kindly notify the clerk, we will see that that is done.
Mr. Palmer. Thank you, Mr. Chairman. That is my intention and
I think the intention of other witnesses for the Wier bill. I have
filed a written statement with the clerk, and I intend to cover the,
salient points briefly, which I have in note form.
The Chairman. In the event you do abbreviate your statement,
you may rest assured that your full statement will be made a part of
the record.
Mr. Palmer. Thank you, sir.
If it is proper, I would like to say just a word or two about the
testimony of the previous witness. Certain of his statements I am
sure our group would agree with wholeheartedly.
Do you mind my standing, Mr. Chairman ? I speak a little better
standing.
The previous witness said that the results of fluoridation in Grand
Rapids were "'alleged.''' He ug,ed the word "alleged" several times.
We find that most of the reports on the brilliant results of fluorida-
tion on children's teeth are not based on a very scientific basis.
Also, the witness said that this is a matter for the States and local
communities to decide. AVe would agree with this wholeheartedly if
it were not for the fact that as some of the members of this committee
have said, the Federal Government is already into that problem up
to its neck. The Public Health Service seems to be the sparkplug
that generates the desire for fluoridation in communities throughout
the country and as far away as Alaska.
FLUORIDATION OF WATER 17
The previous witness has referred to Grand Rapids as a city of
176,000 people. If the people of voting age in the city of Grand
Rapids had received information on both sides of this question, not
merely the information that the United States Public Health Service
and the local health officials wished to give them, if they had received
a fair appraisal of the question of fluoridation on both sides, I doubt
very much that Grand Rapids would have fluoridation because, as
your colleague, Dr. Miller, once said on the floor of the House, almost
every time the question of fluoridation has come to a public vote, it
has been defeated. We know of only one city, San Francisco, where
a vote on the question won. In that case most of the people who
voted for it thought they were voting for the continuance of the use
of chlorine in the water as a purifier.
1 am not a scientist. I have been a student of this subject for about
2 years. There are volumes of printed literature on the subject, ex-
cerpts from some of which I am attaching to my prepared statement.
Just as a matter of information, the organization I am speaking for
was the result of the efforts of two freedom-loving women who per-
haps did not have so much objection to the presence of a certain amount
of fluorine in public drinking water as they did to the fact it was be-
ing forced on tliem without their consent. Their objective was to
give the public both sides of the story and they expected the District
government to cooperate. However, whenever membei"s of the Dis-
trict govermnent were invited to appear, representatives of the Dis-
trict government refused to cooperate. In one radio broadcast of a
half hour, 15 minutes were to be given to us and 15 minutes to the
other side, and the local dental authority said he would not appear, that
he i)referred to let sleeping dogs lie. I do not know whom he was re-
ferring to as the dogs, but they were not there.
We have had various requests from various parts of the country, and
from as far away as Alaska, to form a national organization which
could spearhead this drive against compulsory fluoridation, and re-
cently we changed the name from Citizens Committee on Fluoridation
to National Committee Against Fluoridation. We were against this
before, but some people did not quite understand that.
We have found great disagreement among the proponents of fluori-
dation as to the quantity, as to the method, and as to the results. You
will find some disagreement among our witnesses. Some of the
witnesses who will follow me may disagree with some of the things I
say. That is because the whole subject is up in the air. It is unknown.
Science does not know the effect of fluorine, even in minute quantities,
over a life span. The question of deaths from heart disease and
nephritis in Grand Rapids was brought up. We will not claim that
the fluoridation of water had any effect in the deaths from those
chronic diseases, but it cannot be proved that it did not.
In my prepared statement there are several references to the chem-
ical properties of fluorine and its derivatives. I want to read one
paragraph from an advertisement of the International Nickel Co.,
which manufactures equipment for the handling of chemicals and
apparently at last felt it had discovered a way to handle fluorine. The
text is brief, and I quote :
Imagine, if you can, an element so tierce it burns up steel. One that claws its
way through firebrick, makes water burn like alcohol, destroys almost every-
18 FLUORIDATION OF WATER
thing it touches. That's fluorine for you. And for over 200 years, chemists
racked their brains to find some material that would hold fluorine for even a
few minutes' study. Numerous materials were tried. Most went up in a flash.
That is why, gentlemen, we believe it is unfair to introduce into
our water supply, for the benefit of a small fraction of the popula-
tion, requiring everyone of every age and condition of health to con-
sume it on a life-long basis.
Now, I am resuming my prepared statement concerning the policy
of fluoridation by itself. That has been brought up a number of times
by members of this committee.
We know very little of what the United States Public Health
Service is doing, because the United States Public Health Service
does not publish a statement, so far as I know, of how it is going about
the job of promoting fluoridation.
We have been told of flying squadrons of bright young chemists,
bright young scientists who have gone from city to city, meeting
with chambers of commerce, boards of education, parent-teachers
associations, medical and dental scientists, to tell them the bright side
of flouridation, that will preserve the kiddies' teeth and I grant you
that anything that is for the children, of course, has a strong emo-
tional appeal.
We find that State health departments, dental societies, and
others have joined in this cry; and we find that also in some of these
institutions, having research projects and other projects which are
financed by grants in aid of which the United States Public Health
Service holds the purse strings, there may be no analogy between
those, but we have found, gentlemen, that scientific witnesses who
appeared before the Delaney Committee 2 years ago and were bitter
in their denunciation of fluoridation are now unwilling to testify
before this group, or now find it inconvenient. The inference is
drawn that inasmuch as each of the institutions with which these
witnesses are connected is receiving a grant-in-aid of some kind, that
while, personally, no pressure may have been brought to appear may
be inspired by a wish not to offend the United States Public Health
Service.
Gentlemen, much of the objection to compulsory mass life-long
fluoridation is based upon the question of toxicity, to the poisonous
or injurious nature of fluorine taken in small quantities over a long
period of time.
Something more than 2 years ago there was held here in Washington
under the auspices of the United States Public Health Service and the
Children's Bureau what was known as the Fourth Conference of State
Medical Officers. A printed report of the proceedings was available
for a time, but seems to have disappeared pretty much. Anyone who
reads that with an open mind, I think, behind closed doors certain
officers of the United States Public Health Service, and certain State
health officers laid themselves open.
For instance, the spokesman for fluoridation was one Dr. F. A. Bull,
director of dental education for the Wisconsin State Department of
Health, and in one place, and I am quoting, he said — Dr. Bull was
talking about the toxicity of fluorine, and said :
When they take us at our word, they make awful liars of u.s.
FLUORIDATION OF WATER 19
I would not use that word "liars" if it were not in an official Gov-
ernment statement.
I would like, with your permission, to quote just a little more from
Dr. Bull, who occupied practically the entire morning and was intro-
duced by Dr. Knudson, formerly of the United States Public Health
Service.
Dr. Bull stated :
If you can — I say if you can, because five times we have not been able to do
it — keep fluoridation from ?:oing to a referendum. After you have just a little
experience, you will find you can walk into a mayor's office, after about three
sentences, you will know whether he is for fluoridation or against it.
Then going on, Dr. Bull says :
Now, in regard to toxicity, I note that Dr. Bain —
Dr. Bain was the lady doctor representing the Children's Bureau —
used the term "adding sodium fluoride'' we never do that. That's rat poison.
And I would not use the term ''rat poison" either, if it were not in an
official statement by a pro-fluoridationist.
Continuing with the statement :
You add fluorides ; never mind that sodium fluoride business because in most
instances we are not adding sodium fluoride anyhow. All of those things give
the opposition something to pick at and they have enough to pick out without
our giving them any more. But this toxicity question is a difficult one. I can't
give you the answer on it. After all, you know fluoridated water isn't toxic.
But when the other fellows says it is, it's diflScult to answer him. I can prove
that we don't know the answer to that one, because we nad a city of 18,000 that
was fluoridating the water for 6 or 8 months. A campaign was started by organ-
ized opposition on the grovind of toxicity. It ended up in a referendum and they
threw out fluoridation.
Gentlemen, there is an example of scientists being unwilling to let
the public decide ; as the gentleman who preceded me said, if you let
the community decide, all right. But if the Federal Government is
providing one of its agencies with money to propagandize fluorida-
tion, right or wrong, let the Federal Government provide an equal
sum of money to give the opposition information, and there is plenty
of it.
Now, I am asking in my prepared statement that fluoridation live
up to its claims. We have reports of pilot experiments at Newburgh,
N. Y., Grand Rapids, Mich., Saginaw, Mich., Evanston, 111., and there
are probably others.
Now, we say the statistics, and I will give you the reason for that
also a little later on, that the statistics received from these pilot ex-
periments are misleading in that they do not go below surface indi-
cations. We say also that the beneficial results obtained in the pilot
cities, where fluoridation was compared with nonfluoridation cities,
is probably deceptive, because other methods than the fluorine w^ere
used.
Now, to get at some real statistics that we can rely on, I would like
to compare the two cities of Brantford, and Toronto, Canada. In
Brantford, a 31 percent improvement was announced by the city health
authorities after 6 years of fluoridation ; that is 31 percent less decay,
filled teeth or missing teeth.
In Toronto, during the same period, which did not fluoridate its
water, an improvement of 45.3 percent was reported by the city health
20 FLUORIDATION OF WATER
authorities. Thus comparing the 2 percentages, Toronto showed 46
percent better result with cliildren than fluoridated children. Then
the city authorities in Toronto said it is simple ; we merely taught them
proper hygiene ; we taught them proper diet; we taught them exercise,
and we taught them how to brush their teeth, thoroughly, regularly,
and properly, to avoid sweets, to avoid carbonated drinks, and to eat
the right sort of foods. That will go hand in hand with any reason-
able public health measure that has for its aim the saving of the
children's teeth.
Now fluoridation is prescribed; it is prescribed by primarily the
United States Public Health Service, as a nationwide prescription,
although their scientists differ. Some say as little as one-half of 1
part per million is injurious; some say that one part is helpful, and
not injurious; some say 1.2 to 1.5 percent. They do not agree, and
I do not believe that they know.
We would like to know, granting that the recommended amount of
fluorine is correct, we would like to know how accurately that pre-
scription is filled. When you gentlemen get a prescription from your
doctor, you take it to a competent pharmacist to have it filled. We
have a little statistics on that. But an article appearing in Water-
works and Sewage magazine signed by the sanitary engineer of the
city of Charlotte, N. C., in which a table of differences of fluorine
content in samples of water taken each month for 12 months from
August 1950 — -from September 1950 through August 1951, showed
a difference of as much as 15 parts per million above the accepted
dosage to 35 percent below, or a difference in range from top to
bottom of 50 one- hundredths part. In other words, half of the
prescribed dose.
The findings of the water department were also checked by the
health department separately, by the Charlotte Water District, and
by an Army base in that area which drew its water from the Char-
lotte district. Each 1 of the 4 cities that made this test differed from
the other materially ; some ran even higher than the 15 percent shown
by the water-plant test. In no single month was there complete
agreement of all four tests. And what I think the public should be
told is when there is an excess of fluorine in the water over the pre-
scribed dosage, where does it come from? And when tliere is less
than the prescribed dose, where did that fluorine go ? I think it will
be brought out by witnesses here that some of that .fluorine probably
is stored up in the pipes somewhere along the line; certainly if water
goes into the pipe at the plant with certain concentration, it ought
to come out a few blocks or a few miles away from where it went
in ; should it not ?
It comes out sometimes with a higher content and sometimes with
a lower content.
That is one of the mysteries that makes people frightened and
skeptical about the assurances they are constantly receiving that this
thing cannot hurt anybody.
Now as to the corrosive action of fluorine on water-plant eq^uipment.
I read you briefly from what the International Nickel Co. said. I am
going to give you a little of the experience of Madison, Wis. Madison,
Wis., is proud to say, for about 5 years, it was ahead of the rest of the
country in fluoridating its water. Madison is so confident that,
instead of using one of the fluorides, or the sodium fluorides or the
FLUORIDATION OF WATER 21
sodium silicate fluorides, it used hydrochloric acid. That is the stuff
that burns up glass and burns up iron and wood, and a drop of it on
your hand would probably cause an incurable sore. It is used because
it is cheaper as it mixes with water. But I am going to quote briefly
from a statement by Mr. H. E. Worth, assistant sanitary engineer of
the State board of health of Wisconsin, who, by the way, is strongly
in favor of fluoridation. His statement was made, at a conference on
fluoridation at the University of Washington in Seattle, and I believe
we may have witnesses here who were present at the time that state-
ment was made. If you will bear with me, I would just like to give you
some of Mr. Worth's statement. Incidentally, after receiving a copy
of Mr. Worth's statement, I wrote him and asked him if it were
correct, if he had been properly quoted, and he sent me a copy which
agreed with the copy that I had, and he had some other information
added to it. I picked out some of the more salient points, and I quote :
Some operating difficulties have been noted, sucli as the clogging of solution
piping by disposition of inert materials, the presence of foreign material consist-
ing of pieces of heavy paper, slivers of wood, nails, and staples, found in com-
pound described as 98 percent pure white sodium fluoride. There is also the more
difficult problem of incrustation.
This problem, common in hard waters, has been experienced in soft waters
as well. When mixed with the water supply, sodium fluoride forms a precipitate
with the calcium in the water which plugs in the injection lines, incrusts tanks
and solution chambers.
Even in soft-water makeup, precipitates form in the tank which, if not periodi-
cally removed, plugs the feeder. Control of this condition is secured by periodic
backwashing of the tanks which brings the sludge to the top where it can be
removed. Madison uses cast iron for both tanks. Originally, attempt was made
to feed into the well discharge lines. Severe erosion at the point of installation
was ever present, however, requiring weekly replacement of the fittings.
Gentlemen, may I repeat those last few words :
Erosion of the metal-mixing machinery requires weekly replacement of the
fittings.
We cannot replace our internal fittings very well. Sometimes they
do, but once our liver and kidneys and intestines are gone, we prob-
ably will not get any more.
That seems to me, Mr. Worth's statement seems to me, to answer
in part the question of why in the city of Charlotte, X. C, they found
higher and lower concentration when the city plant was trying to keep
a level of 1 part per million.
We have talked here of two instances where we have expert tech-
nicians handling the equipment, both of them sanitary engineers
who have been schooled in the work and know their stuff. And now
the next question is, then, what would be the result if the village
barber or the tinsmith were to be the man handling the fluoridation
equi[)ment t And you may think that is pretty far fetched, to refer
to the village barber or the tinsmith. But let me go back to Dr. Bull —
at the Fourth Annual Conference of State Dental Officers. Dr. Bull
was describing this question of the safety of mixing and metering
equipment. Apparently a number of delegates, of engineers and
citizens from other States, had come to Madison, Wis., which had
pioneered in fluoridation, and were asking for enlightenment and
this is what Dr. Bull says, and I quote :
So we took them to several little installations where the village barber is the
waterworks man, or the hardware man is the w^aterworks man. And we turned
them over to him, and let the engineers question him and find out what he is
'^OSTo
Br.Tr-
'A
22 FLUORIDATION OF WATER
doing and how he is doing it. Now, in large cities, we do not concern ourselves
because they know how to handle the equipment and have trained help. But
in a small community, where the barber is going to operate the feeder, if
anything goes wrong, he throws up his hands.
Gentlemen, is there any wonder that citizens throw up their hands
when there are such releases as that in published statements?
Now, in the city of Washington, as I told you, the District officials
refused to hold hearings, refused to hear those who wanted both
sides of the facts brought out. They have made up their minds and
they went ahead and put fluoridation in without public consent.
They probably have expert people working in the city water plant.
But those emploj^ees — they are not pharmacists, they are dealing with
a highly toxic element. They are putting into the city water of the
District of Columbia and its environs which draw from the same
District, 2,800 pounds of sodium silicate fluorides each day. That
amounts to more than 1 million pounds, 500 tons, and the quantity
has increased as the population in the area increases.
The yearly cost to the District taxpayer for the fluorine alone, not
counting the cost of the superintendent, labor, and propaganda, is
$71,500. That seems small. But it is large. When the District's
estimates made by waterworks officials shows that for every pound of
fluoride put into the public water, 99.6 percent is wasted, used for
laundering, washing cars, and it goes to people who cannot be bene-
fited by fluoridation, as it is used in industrial plants and what not.
So out of our $71,214 invested in the chemical alone, in the District
of Columbia, only $286 worth of this treatment can reach children
who might be benefited and benefited only partially.
We have heard of one town, and I think it is Grafton, Mass., where
a 17-year-old patient in a school for the feeble minded is the one
who handles the fluoridation plant.
I want to get to the very much publicized question of the endorse-
ment of fluoridation by the American Medical Association. If one
reads the statement issued by the secretary of the American Medical
Association during the Delaney hearings, you will find that the AMA
council endorsed fluoridation in principle only; the council said it
does not know of any harmful effects; they did not say that it was
not harmful ; they did not say it was ; they said, "We do not know
of any harmful effect." It is a good deal like the man who said he
did not know the gun was loaded. And they did not recommend
that any community adopt fluoridation but they did recommend
further research and study on the question of toxicity.
Gentlemen, I do not think that is a very strong endorsement of
fluoridation by the American Medical Association. It smacks more
of professional courtesy toward the American Dental Association
so that the doctors don't want to encroach upon the dentists and the
doctors of the American Medical Association do not want to have
the responsibility — of assuming responsibility of any later harm that
may come along.
Now, those who are for fluoridation say there are very strong prece-
dents for universal fluoridation, compulsory fluoridation ; that it does
not require public approval. They cite among other things the prece-
dent of chlorine in public drinking water, the use of fluorine is not
analogous to the use of chlorine, because the function of chlorine is
FLUORIDATION OF WATER 23
simply to remove the harmful bacteria or organisms and the chlorine
can be removed from the water by boiling ; fluorine cannot ; chlorine
can. By boiling the water, fluorine becomes more concentrated.
They also use compulsory vaccination against smallpox and per-
haps some other diseases or the compulsory isolation of typhoid vic-
tims in some communities, although those practices are not universal.
Again, they are not analogous to the addition of fluorine to water
because they are definite measures against contagious and infectious
diseases.
According to the authorities, the cause of dental caries is still an
unknown question. No one has ever found an organism in a tooth,
either adult or child, which could be identified as the cause of dental
decay. And tooth decay is neither contagious nor epidemic nor a
menace to public health.
Now, another precedent for universal fluoridation, but one which
the proponents of fluoridation carefully refrain from mentioning,
I believe was mentioned here this morning, and that was an attempt,
a generation ago, to introduce iodine by law into the public drinking
water of all communities in the United States as a preventive or
goiter. That was done in some communities. I believe Rochester,
N. Y., which has since turned thumbs down hard on fluoridation, was
the first one. Hardly had that campaign started, however, than the
medical profession discovered that the addition of iodine, instead of
preventing goiter or curing goiter, encouraged the development of
goiter and the process was stopped and those who had proposed it
were discrediled.
Now, I want to touch a little bit upon the question of Government
responsibility in this question of fluoridation.
You gentlemen have probably covered it better than I have, but it
has been suggested that H. R. 2341 might invade State police power by
prohibiting a State or a community from doing, as a health measure,
what it sees fit. We submit that the Federal Government is already
doing that by appropriating large sums of money to the United States
Public Health Service, part of which money is used directly in the
propagandization of fluoridation and parts of which must bear some
reasonable relationship to fluoridation because it is used as grants-in-
aid to various institutions, where some people, once opposed to fluori-
dation, have now slightly changed their tune, or quit talking about
it entirely. We believe that the measure before this committee, which
is probably imperfect, as it was probably written so, contains no
penalties ; we believe that part of it, however, if the whole of the bill
is unacceptable to this committee, and to the Congress, we believe the
part of it which would prohibit the fluoridation of water in any such
area as the District of Columbia, which is under direct Federal control,
the Territory of Hawaii and the Territory of Alaska and in veterans'
hospitals and military installations and other communities would be
proper and legal.
We would like to see it banned or abandoned throughout the United
States. That may be impossible by Federal law, but what is suggested
in that part of H. R. 2341 would be a long step toward bringing to
public attention the fact that the Congress does not look with favor
upon the propagandizing methods of one of the Government agencies.
Thank you.
24 FLUORIDATION OF WATER
The Chairman. Thank you very much. Are there any questions,
gentlemen ?
Mr. Dolliver?
Mr. DoLLi\^R. I notice that you represent the National Committee
Against Fluoridation.
Mr. Palmer. Yes,
Mr. Dolliver. And were formerly head of the committee on
fluoridation.
Mr. Palmer. That is right.
Mr. Dolliver. Will you give us an idea who composes that
organization ?
Mr. Palmer. I am glad you asked that question. Mostly women.
Mr. Dolliver. Mostly women?
Mr. Palmer. I would say that the membership is over 65 percent
women, most of them housewives.
Mr. Dolliver. Are there any scientists among them ?
Mr. Palmer. Yes, we have some doctors and we have some dentists
and some chemists. The membership has the nucleus here in Washing-
ton ; it is not great. I believe it is something like 375 members who
have gathered.
Mr. Dolliver. How many?
Mr. Palmer. Something like 375, but we are the nucleus now of
various groups in various parts of the country. There are a good
many of them from Florida to Massachusetts and as far as Anchorage,
Alaska, where a group has been formed.
We do not ask their individual members to become members of our
group, but we have changed to a National Committee Against Fluori-
dation because most of these people in outlying districts wanted an
organization with a national status in the Nation's Capital.
Mr. Dolliver. How many scientists are connected with the
organization?
Mr. Palmer. You mean physicists and people like that?
Mr. Dolliver. I mean in the medical or dental term.
Mr. Palmer. I do not know. We have dentists, and we will have
some in here as witnesses at these hearings who are graduates and
practicing dentists and physicians.
Mr, DoLLi\^R. How do you finance the organization ?
Mr. Palmer. As best we can, Mr. Dolliver.
Mr. Dolliver. Do you have membership dues ?
Mr. Palmer. We have annual dues of $1 at the present time and
frankly some of them are reluctant about giving up the buck. The
public'apathy and inertia to this thing is astounding. People cannot
see, they cannot taste, they cannot taste flour ine in their water and
they say, I feel all right, so what? But there are people who are
going a little bit beyond that. Some are saying that is unethical and
moral invasion of their rights to control their own bodies. Other
people are rather vocal; they do care. Some of them are at times
emotional. Maybe some of our witnesses here will appeal to you as
a bit emotional. Forgive them if you can because it is an emotional
subject to them ; it is something new and dangerous.
Excuse me for wandering away from answering your question,
directly. Congressman. Have I cleared up the point ?
Mr. Dolliver. You mean to say that your only financial support
is from the $1?
FLUORIDATION OF WATER . 25
Mr. Palmer. No.
Mr. DoLLivER. From the 375 people ?
Mr. Palmer. No.
Mr. DoLLivER. There must be somebody paying some of the ex-
Deiises .
Mr. Palmer. As far as I know, the biggest single contribution, and
it is from a member, has been $50. There have probably been a few
$50 contributions; there have been some $25, and more $10's and moi-e
$5's. We do not spend much money.
Mr. DoLLiVER. Wlio is your treasurer?
Mv. Palmer. The treasurer— I will have to ask Mrs. Adams.
Mrs. Adams. Mrs. Bertha B. Forney.
Mr. Palmer. If the Congressman is looking for information as to
whether we have an "angel," whether we have any financial backing,
whether any organization is back of us, there is none.
The assertion has been made here that— and it has been made else-
where, of coui-se, that this is a bunch of Christian Scientists. I think
we do have some Christian Scientists among us. I personally am a
Presbyterian. I do not think we have ever inquired as to the religious
beliefs of our members or whether they had any or not, or much as to
their occupation. We are not backed by anybody who is digging up
a lot of money, because we do not spend a lot of money.
The cost of preparing my statement and the statement of another
witness was borne out of my pocket. I happen to have a fair salary
myself, and I am willing to spend some of it in this direction.
Mr. Dolliver. When did you first become interested in the subject ?
Mr. Palmer. When two ladies I mentioned came to me separately
and said this question of fluoridation was bothering them. I knew^
them both. They did not know each other. "Can you suggest some-
body who would be the nucleus of an organization," and I said to Mrs.
Adams, "I wish you would get in touch with Mrs. Philadelphius,"
and to Mrs. Philadelphius, 'T wish you Avould get in touch with Mrs.
Adams." and they did.
Then they came to me and they said, "We feel that we should incor-
porate. Can you recommend a lawyer."
Well, I know of a young lawyer who is public spirited, and I said,
"AMiy don't you go 'to Bob Wrighter, or I will phone him if you
want me to."
As a result, there was a little gathering of 5 or 6 people; I was
invited to attend, and I had nothing ofiicially to do with it. The
organization was formed, incorporated, and the first thing I knew, I
landed on the board of directors. I do not know why but I am
Mr. Dolliver. Is fluoride an element?
Mr. Pal:mer. Yes, it is one of the helogen gases, along with fluorine
and several others. It is one that is extremely deadly, along with
liydrocyanic gas.
]\Ir. Dolliver. Is it related to the chlorine family ?
Mr. Palmer. It is related to the chlorine family, yes, of the helogen
group; there are about seven of the helogens. I am not a chemist,
but they are all of that family; they are all rather fatal in their
reactions upon animal and vegetable life, and u])on metal.
Mr. Dolliver. Well, chlorine is quite extensively used to purify
water.
26 FLUORIDATION OF WATER
Mr. Palmer. Yes.
Mr. DoLLivER. There are a great many cities use it including Wash-
ington ?
Mr. Palmer. Surely; chlorine is very valuable for that purpose.
Chlorine does not have corrosive properties.
Mr. DoLLivER. I beg your pardon ?
Mr. Palmer. Chlorine does not have corrosive properties, the cor-
rosive properties that fluorine does. I have talked with doctors about
this, about the constant ingestion of small amounts of fluorine, whether
it might produce chronic conditions. The reason why fluorine is not
suspected is the fact that in the settling process of city-purified water,
most of the fluorine is evaporated — I mean, chlorine. Fluorine will
not evaporate. Chlorine will evaporate, but fluorine will not evaporate.
When you cook your vegetables at home in water in which the
fluorine may be so strong that you can smell it, or taste it, and when
you come to cooking it, the process will drive off the chlorine — and I
am getting the two terms confused. Fluorine will concentrate. I am
going to get these w^ords mixed up here if I am not careful.
Mr. DoLLivER. Of course, there are many compounds of both of
tiiese elements, chlorine and fluorine; are there not?
Mr. Palmer. Yes ; the principal compound of fluorine or the fluo-
rides which are sold, in which the acid has mixed with metal. Fluo-
rine has the property of uniting directly with most metals. It has a
very, very strong affinity for calcium, according to the chemical ex-
perts. For that reason, the excess of fluorine that we may get from our
food, or our drinking water may be stored up in the bones, causing
arthritic conditions — but I would rather not try to discuss that, be-
cause I am not an expert.
Mr. DoLLivER. We will have some other witnesses who are to cover
that?
Mr. Palmer. The other witnesses will testify on that.
The Chairman. Thank you very much. Are there any further
questions?
Mr. Derounian. Mr. Palmer, I was interested in that part of your
statement, "Wlien metal bursts into flame." Do you think that is a
fair representation of the effect of fluorine on water ?
Mr. Palmer. Not fluorine and water ; no ; one part to a million. I
was giving there only the nature of the element itself ; not the effect
of long ingestion of one part per million.
Mr. Derounian. Is fluorine explosive?
Mr. Palmer. Fluorine is said to be the bad boy in the chemical
world. It is the most unpredictable and difficult to handle of all of
the elements known to science.
Mr. Derounian. Would you say that hydrogen is explosive ?
Mr. Palmer. Well, hydrogen burns. It is explosive ; it is explosive
when it is in a container, when it is burnt in a restricted area.
Mr. Derounian. It is potentially a dangerous element; is that
correct ?
Mr. Palmer. Yes.
Mr. Derounian. Do you think we ought to stop drinking water ?
Mr. Palmer. No; because we need hydrogen in our economy just
as we need chlorine. We need chlorine, a certain quantity of it, to
form hydrochloric acid ; that is a part of the digestive juices of the
FLUORIDATION OF WATER 27
system. According to some scientists, one scientist wliom we expect
to be here — expected to be here — fluorine phiys no part in the body
metabolism, and it is not an element that is necessary in the develop-
ment of the human organism, and it is there as an invader. We could
not live very long without hydrogen ; we can live without fluorine.
Mr. Derounian. Have you made any surveys of the efi'ect of fluo-
rine in the water in the District of Columbia on the health of the
imbibers ?
JMr. Palmer. No ; it has not been established long enough.
Mr. Derouxiax. It has not been ?
Mr. Palmer. No ; it has only been in use about 2 years.
j\Ir. Dergunian. And yet you think you can make a statement that
it is harmful to the user?
Mr. Palmer. I say that scientists, certain scientists, have developed
the fact that its long ingestion, its use with the experiments on animals,
have created conditions, and tliey have cured .them by taking the fluo-
rine away and have reinstituted the condition by returning the animal
to the fluorine diet. Those are questions, sir, that the scientists should
answer, not a layman.
Mr. Derouxiax. Why do you think the Public Health Service of the
United States is for fluorine ?
Mr. Palmer. I do not think there is any question about that ; we have
seen their printed literature, their manual went out to promote fluori-
dation— and I was going to say how to put fluoridation over — their
little booklet that answers, supposed-to-be answers, to the questions
raised by the opponents. A pamphlet which was received in my office
recently from the Public Dental Officers of the State of Pennsylvania,
from Harrisburg, which had been at the instance of the United States
Public Health Service and was distributed throughout the country.
The fact that United States Public Health Service has caused these
conferences of State dental officers, called them to Washington and, I
believe, in some instances, have paid their expenses to indoctrinate
them on the question of fluoridation and tell them how to promote
it — and that is not a secret.
Mr. Derouxiax. Do you think that they would openly advocate any-
thing that was detrimental to the health of the people of the United
States?
Mr. Palmer. They might, sir. They advocated iodine at one time.
Mr. Derouxiax. Well, do you think it is a Communist plot ?
Mr. Palmer. No, no, no ; certainly not,
Mr. Derounl\n. Some people claim that ?
Mr. Palmer. Some people would say that about anybody. No, I do
not think there is any such Communist plot.
Mr. Derounl4X. Nothing further, Mr. Chairman.
The Chairman. Mr. Hale.
Mr. Hale. Mr. Palmer, is this national committee a local group or
is it spread over the country ?
Mr. Palmer. We have — most of our members are near Washing-
ton, but we have members as far away as California, Florida, and
Alaska, and Maine and Massachusetts. Not many. We have not the
facilties or the funds to go out and make a drive to get a lot of
members. We should have 10,000 instead of 375, because I beli^vf^
there are 10,000 people. It is just a little group, just as we are, with
48391—54 3
28 FLUORIDATION OF WATER
a small amount of money, and we cannot go out and do the kind of
work that a big Government agency can.
The Chaikman. We thank you, Mr. Palmer, for your statement.
Mr. Palmer. Thank you, Mr. Chairman and gentlemen.
I understand that my full statement will appear in the record ?
The Chairman. Yes. Without objection, the statement of Mr.
Palmer will be inserted in the record.
(The statement referred to follows : )
The Miscalculated Risk of Mass Fluoridation — A Statement by Claude N.
Palmer, Member of the Board of Directors, in Support of H. R. 2341, Pre-
sented ON Behalf of the National Committee Against Fluoridation (For-
merly Citizens Committee on Flltoridation )
Part I
"May God grant me the wisdom to discover my own mistalies." With this
prayer, the young scientist, Arrowsiuith, began his career as a researcher into-
the causes and prevention of contagious disease. The National Committee
Against Fluoridation, a nonprofit, nonsectarian group of American citizens,
chartered under the laws of the District of Columbia, will endeavor to show
by their own words how this creed of medical and research ethics is ignored by
those who advocate most vociferously a regimen of mass medication by adding
fluorine to community water supplies.
We lay no claim to being a group of scientists, though our membership, which
extends from Maine to California and from Florida to Alaska, includes physi-
cians, dentists, chemists, educators, and other professional men, as well as lay
citizens from all levels of society. Since other witnesses will discuss fluorida-
tion from a purely scientific viewpoint, in which some differing opinions may
be expressed, this statement will deal mainly with certain contradictory asser-
tions made by the proponents of fluoridation as to its possible benefits and
potential dangers.
the chemical properties of fluorine
On one subject, however, no disagreement will be expressed on either side
of this issue. As every standard work on chemistry shows, no doubt exists
as to the violent reaction of fluorine and its compounds on both animal and
vegetable life. In support of this fact, we quote in part a statement of the
International Nickel Co., published under the caption, "When Metal Bursts
Into Flame."
"Imagine, if you can, an element so flerce it burns up steel. One that claws
its way through flrebrick * * * makes water burn like alcohol * * * destroys
almost everything it touches. That's fluorine for you. And for over 200 years
chemists racked their brains to find some material that would hold fluorine * * *
for even a few minutes' study. Numerous materials * * * were tried. Most
went up in a flash."
With these and other facts about the violent nature of fluorine and its com-
pounds readily available, many people have become alarmed at the addition
of this chemical to their drinking and cooking water, and are not convinced
by statements from unknown sources, no matter how official, that taking this
element into their systems for the rest of their lives, even though in minute
doses, cannot possibly have a toxic effect upon their own and their children's
future health.
These doubts and anxieties would not have been so widespread, nor would
public resistance to and defeat of fluoridation have occurred in so many locali-
ties, both before and after its inception, were it not for the fact that this system
of compulsory mass medication was in many instances introduced without the
knowledge and consent of those who might be injured by it and often despite
the protests of people who considered it an invasion of their personal rights
and liberties.
the policy of fluoridation by stealth
That the advocates of fluoridation have adopted a deliberate policy of keeping
the general public in ignorance on the subject — at least preventing a referendum
vote in the community if possible— is shown by the record of proceedings at;
FLUORIDATION OF WATER 29
the fom-tli annn.Ml confereiioe of State dental directors and tlie Public Health
Service in Washington, D. C., in June 1951. At this meeting Dr. F. A. Bull,
director of dental education, Wisconsin State Board of Health, and evidently
keynoter for the advocates of lluoridation, said in part as follows :
"If you can — I say if you can. because live times we have not been able to
do it — keep fluoridation from going to a refei-endum. After you have just a
little experience, you will find you can wallv into a mayor's office and after
about three sentences you will know whether he is for fluoridation or against it."
At another point in his address, referring to the toxicity of drinking water
with a concentration of 1 part fluoride to 1 million parts of water. Dr. Bull
is quoted in the official conference proceedings as saying :
"Now, in regard to toxicity, I note that Dr. Bain u.sed the term 'adding sodium
fluoride.' We never do that. That's rat poison. You add fluorides. Never
mind that sodium fluoride business, because in most instances we are not a<ld-
ing sodium fluoride anyhow. All of those things give the opposition something
to pick at, and they have enough to pick at without our giving them any more.
But this toxicity question is a difficult one. I can't give you the answer on it.
After all, you know fluoridated water isn't toxic. But when the other fellow
says it is, it's difficult to answer him. I can prove that we don't know the
answer to that one, because we had a city of 18,000 that was fluoridating the
water for 6 or S months. A campaign was started by organized opposition on
the ground of toxicity. It ended up in a referendum and they threw out fluori-
dation."
With such mixtures of professional candor and confusion reaching the ears of
intelligent people, it is easy to understand Avhy such communities as Los Angeles,
Seattle, Minneapolis, Chicago, Kansas City, St. Louis, Philadelphia, Reading,
New York, Rochester, Boston, Cambridge, Worcester, Cincinnati, Tampa, Lan-
sing, Tallahassee, and some 300 other places rejected fluoridation either before it
began or after it had been in operation, sometimes for a year or more.
THE FLUORIDATION PROPAGANDA LINE
Besides telling only what it wants the public to believe, carefully omitting any
reference to the possibility of chronic fluorine poisoning, the proponents of
fluoridation adroitly sidestep all mention of the rising flood of opposition that
faces them in well-informed communities. The public hears only about new
installations ; never of rejections. We are asked to believe that many cities
and towns eagerly await fluoridation ; never that hundreds of communities have
rejected it.
It is not strange that authentic data on the number of fluoridated areas are
difficult to obtain, since profluoridatiou propaganda has used approximately the
same figures — 600 to 700 — during the past several years. Fluoridation pro-
ponents have, however, recently made the satement that some 17 million
American citizens are now drinking artificially fluoridated water. As the lluori-
dation program has been running in high gear for more than 10 years, this figure
is not impressive, since it represents only about 10 percent of today's national
population.
Compared with the rather poor showing on a nationwide basis, after nearly a
decade of ceaseless propaganda and enthusiastic endorsement by medical and
dental societies, public officials, chambers of commerce, and welfare groups, it
is significent that the 17 cities previously noted, all of which liave rejected out-
right or postponed fluoridation of their water supplies, represent a population
of more than 20 million. It is thus apparent that the.se few cities in whicli
fluoridation has been turned down outnumber by upward of 3 million persons the
most optimistic claims of profltioridation enthusiasts.
We believe it safe to say that more resistance would have developed and more
communities would have abandoned the idea of fluoridating their water sys-
tems if the public had been informed of what was going on, and if both sides
of the issue had been discussed openly. That this was not the policy of thosfc,
most interested in fluoridation is shown by the fact that many people are un-
aware that fluorides are being added to their drinking water, and do not know
about the difference between fluorine and chlorine in their action upon animal
organs and tissues.
In this connection, it is doubtful that all Members of Congress know whether
or not the public water supplies in their own districts contain fluorine. A sur-
vey among adult citizens of Newburgh, N. Y., a community that has received more
30 FLUORIDATION OF WATER
profluoridation publicity perhaps than any other town, revealed that only 8
percent had any idea as to what "fluoridation" means, 72 percent said they did
not know, the remaining 20 percent were undecided. Of the Newburgh group,
only 22 percent were aware that fluorides were added to their drinking water,
while 61 percent did not, but 83 percent said they believed they should have
been consulted, and only 2 percent raised no objection,
DOES FLUOKIDATION DO WHAT ITS BACKERS CLAIM FOR IT?
Other witnesses will discuss the therapeutic and physiological sides of this
issue. It is my intention to point out the difliculty of obtaining authentic and
imbiased data regarding the results of fluoridation in its job of reducing dental
caries among children up to 8 years of age. While there is little doul)t that
fluoridated drinking water makes the teeth of young children somewhat more
resistant to decay, there is much difference of opinion among dental authorities
as to whether fluorine alone can be credited with producing the result. Some
observers report that when fluoridation appears on the scene, certain other
influences take a hand in the work, contributing a considerable share to its
outcome.
Since data on all pilot experiments in this country are apt to be influenced
by the experimenter's personal predilections, no matter how conscientious
lie happens to be, we take the experience of Canadian cities to show the error
of giving full credit to fluoridation for reducing tooth decay among school chil-
dren in one place, while equally good results were obtained in another without
fluoridation.
Brantford, Ontario, adopted fluoridation in 1944. After 6 years its public
health officer reported (February 1950) a reduction of 3l percent among chil-
dren of school age requiring dental repairs. This report gave a sudden spurt
to the campaign for public water fluoridation in Toronto. But health oflicials
in Toronto had meanwhile been watching the condition of their school children's
teeth. When the cry for fluoridation became insistent, they announced that
dental decay among Toronto's children declined 45.3 percent during the same
period of years.
The reason for Toronto's experience is simple. While Brantford was treat-
ing its children's teeth with fluorine, Toronto was plying its children with in-
formation on proper diet, exercise, and other aids to good health and teeth.
This is an essential to every health program among school children, whether
the community water supply is fluoridated, or whether it remains free of
artificial medication. The Brantford-Toronto picture could be repeated many
times over in this country.
HOW ACCURATELY IS THE FLUORINE PRESCRIPTION FILLED ?
A favorite assertion of the professional and amateur fluoridators is that no
harmful effect is possible from water containing "the prescribed concentration" —
one part of fluorine to a million parts of water — other than a slight mottling
or discoloration of the teeth. This formula completely overlooks the fact that
some persons consume in the course of a day many times the amount of water
consumed by others, that in summer most people drink much more than during
cold weather, that persons afflicted with certain diseases need much more than
the average needed by well persons, and that the susceptibility of one person
to a given treatment differs widely from all others.
Prescribing the same pill to everyone, regardless of age, health, or ability
to withstand its cumulative effect, and telling the patient to take as much or as
little of tlie drug as he pleases, would hardly be considered acceptable procedure
on the part of a practicing physician. Yet men who are not practicing physicians
assume the prerogative of prescribing the same amount of fluorine to every
person in every community on a lifelong basis, despite individual tolerance or
needs.
The "safe" dosage of fluorine is presumed to be one part per million. That is
the amount appearing most frequently in published literature on the subject.
Yet we find an admitted authority on fluoridation, the same Dr. Bull previously
mentioned herein as the official spokesman for the form of universal medica-
tion, telling his fellow dental directors — behind closed doors, of course — that
not 1 part per milion, but 1.2 parts per million is the fluoride concentrate "we
are recommending."
FLUORIDATION OF WATER 31
Granting that this prescription is the last word in fluorine therapy, can we
be sure it is compounded accurately in every case and all circumstances? We
have sound evidence that it is not. In Charlotte, N. C, for example, one of our
larger fluoridated communities, monthly analyses of fluorine concentration at
the city water plant between September 1949 and August 1950 showed variations
from 14 percent above to 35 percent below the prescribed amount, an overall
spread of 48 percent.
This 48 percent variation at the water plant might not be highly significant, if
it were not for the fact that three other monthly tests of the same water drawn
from the same source showed as great or greater variations in fluorine content,
seldom agreeing with each other or with the water plant's analyses. Samples
analyzed by the city health department showed a difference of 51 percent between
maximum and minimum concentrations. The Charlotte water district tests
showed variations of 53 percent during the 12-month period. Tests at a military
post which draws its water from the Charlotte system showed a difference of 51
percent between maximum and minimum fluorine concentrations. While the
latter percentage coincides with that of the city waterworks, it is significant that
in no montli of the 12 were all 4 tests in complete agreement as to the fluorine
content of their individual samples.
If it were true, as promoters of fluoridation assert, that mixing and metering
equipment used to combine fluorides with water are infallible, there would be
only one reason why water enters the city mains with one concentration and
leaves them a few miles away with a higher or lower concentration. This reason
would be that part of the fluoride is deposited somewhere along the line. While
there are indications that this is true to some extent, there is good evidence that
certain amounts of fluoride remain in the mixing device, temporarily at least.
XHE C0RK0SI\^ ACTION OF FLUOKINE ON PLANT EQUIPMENT
Evidence that even the most modern fluoride-mixing equipment in the hands
of expert operators does not always compound the prescription accurately is given
in a public statement by H. E. Wirth, assistant sanitary engineer of the State
board of health, Madison, Wis. Mr. Wirth was quoted as follows in the tran-
script of a discussion on fluoridation at the University of Washington :
"Some operating difficulties have been noted, such as the clogging of solution
piping by deposition of inert materials, the presence of foreign material consisting
of pieces of heavy paper, slivers of wood, nails and staples, found in compounds
described as 98 percent pure white sodium fluoride. There is (also) the more
difficult problem of incrustation.
'"This problem, common in hard waters, has been experienced in soft waters as
well. When mixed with the water supply, sodium fluoride forms a precipitate
with the calcuim in the water, which plugs the injection lines, incrusts tanks
and solution chambers.
"Even in soft-water makeup, precipitates form in the tanks, which, if not
periodically removed, plugs the feeder. Control of this condition is secured by
periodic back-washing of the tanks, which brings the sludge to the toi), where it
can be removed. INIadison used cast iron for both tanks. Originally, attempt was
made to feed into the well discharge lines. Severe erosion at the point of instal-
lations was everpresent, however, requiring iveekly replacement of the fittings'^
[Italic added.]
If sodium fluoride added to public drinking water by the most modern device,
and superintiieded by a professional sanitary engineer, is as difficult to control as
Mr. Wirth's statement admits, we submit that this procedure presents a serious
health prolilem. especially when handled by unskilled persons, such as the village
barber or hardware man. To show that this responsibility is sometimes given
to untrained persons, we again quote from the remarks of Dr. Bull, previously
referred to in this statement :
"So we took them to several little installations, where the village barber is
the waterworks man, or the hardware man is the waterworks man. And we
turned them over to him, and let the engineers question him, and find out what
he is doing and how he is doing it. Now, in large cities, we do not concern
ourselves, because they know how to handle the equipment and have trained
help. But, in a small community, where the barber is going to operate the
feeder, if anything goes wrong, he throws up his hands."
This revelation should make any reasonable person think twice before approv-
ing, let alone promoting, fluoridation in his own or any other community. It has
32 FLUORIDATION OF WATER
been shown that serious mechanical difficulties appear in large cities (Charlotte
and Madison), and that the risk of more serious trouble can be expected in
places where the responsibility is given to unskilled workers. Despite such
hazards, it is understood that the Public Health Service has supplied fluorine-
mixing devices to certain communities at the American taxpayer's expense.
Granting that the formula is correct and safe under all circumstances, it is
imthinkable that the prescription should be filled by the village barber or hard-
ware merchant. Prudence demands that such work be performed by registered
pharmacists, not by handymen with part-time jobs in the local waterworks.
Because of its dangerous nature, one may not buy hydrofluoric acid or other
fluorides from a druggist. Yet these chemicals are now being administered in
wholesale quantities to large groups of people by employees of municipal pump-
ing stations all over the country under the qualified endorsement of the Ameri-
can Medical Association.
Much has been made by fluoridation advocates of this AMA endorsement. In
its statement of some years ago to another congressional committee, the organi-
zation endorsed the program in principle only, said its covmcils "did not Icnow
of any injury" from drinking water with the recommended flourine content, did
not believe such water to be toxic, and "purposely refrained" from suggesting or
urging that any community fluoridate its public water supplies. This statement
does not impress us as an unqualified endorsement of mass fluorine therapy.
HOW GOOD AEE THE PEECEDENTS FOR FLUORIDATION?
Proponents of fluoridation cite the practice of adding chlorine to community
water systems as a precedent for adding fluorides. They also cite compulsory im-
munization against certain contagious diseases, now practiced in many localities,
as analogous to fluoridation. These analogies are not sound, however, since
dental caries is neither epidemic, contagious, infectious, nor fatal. At its
worst, tooth decay is a minor health problem, the causes and prevention of
which are not yet fully understood after many years experimentation and
research.
There is, however, a single precedent in this field of therapy, though it is never
mentioned publicly by the sponsors of fluoridation. We refer to an attempt of
the United States Public Health Service and others a generation or more ago to
promote the universal addition of iodine to public water supplies as a preventive
of goiter. This early attempt to use city water mains as an avenue to mass
medication failed for the simple reason that its backers learned in time that,
rather than preventing or curing goiter, iodized drinking water tended to in-
crease it.
When the facts become known about fluoridation, we believe this therapy will
follow universal compulsory iodinization into the discard. Meanwhile, the
public is being subjected to a regimen of treatment for a minor ailment affecting
almost wholly a small part of the population, the long-range effects of which
are as yet unknown. To determine whether any person will be injured by this
treatment would require observation covering one or more generations. lu
these circumstances, it is difficult to understand why the program was launched
throughout the Nation, after only 2 or 3 years of pilot tests among children under
9 years of age.
THE government's RESPONSIBILITY FOR FLUORIDATION
It has been intimated that Congress may be reluctant about enacting the Wier
bill (H. R. 2341) on the groimd that it might infringe the police powers reserved
to individual S'tate legislatures. This doctrine might be tenable, if the Federal
Government were not already invading such police powers through its Public
Health Service, which is one of the chief and most ardent promoters of mass
fluoridation on a nationwide basis, supplying both fluoride-mixing equipment
and printed publicity for which the Federal Treasury foots the bill-
Thus, the Congress is already responsible for any invasion of State or local
police powers that might be involved in the passage of this legislation, since it
appropriates the funds by which the Public Health Service is able to spread a web
of profluoridation propaganda throughout the United States and even into foreign
countries. Therefore, if the AVier bill is not acceptable to Congi-ess, neither is
the profluoridation program now in progress by another branch of Government —
the United States Public Health Service.
FLUORIDATION OF WATER 33
In conclusion, we submit that the only alternative to enactment of this bill
would be the elimination from future appropriaticms for the Public Health Service
any funds that might be used in futhering the cause of mass fluoridation.
Addendum to a Statement by Claude N. PALJtER in Support of the Wier Bill
(H. R. 2341)
The data herein presented are submitted for inclusion in the record of these
hearings because certain witnesses, who were expected to discuss them, are unable
to be present. The foregoing statement refers briefly to a qualified endorsement
of the American Medical Association regarding the use of fluorine salts in public
water suiJplies as a therapy for reducing tooth decay in young children from birth
to the age of 9 or until their permanent dentition has erupted.
This endorsement, it should be noted, adds that "fluoridation is essentially a
matter for decision by the dental profession." By this qualification, the medical
profession avoids responsibility for any harm resulting from this experiment in
mass therapy, leaving it to the dental profession. As fluoridation is no more nor
less than preventive medicine, and as it affects organs other than the teeth, we
submit that it is ethically improper for dental groups to assume the authority for
insisting that every person in a community shall be compelled to take a toxic
dieinical, which can beneflt only a few young patients and may harm older ones.
We also submit that reports of marked reductions in tooth decay among school
children in fluoridated cities are misleading, in that they rely upon a method of
appraising dental conditions known as the DFM index. This index considers
only the outward evidences of dental health, D for decayed teeth, F for teeth with
fillings, and M for missing or extracted permanent teeth. Since this appraisal
takes into account only surface indications, ignoring structural conditions within
the tooth itself, and giving no thought to the child's internal organs, bones,
endocrine glands, and nervous system, all of which are affected by fluorine, it is
quite obvious that the DFM assay is both superficial and misleading.
WHEN METAL BURSTS INTO FLAME
Imagine, if you can, an element so fierce it burns up steel. One that claws its
way through firebrick, makes water burn like alcohol, destroys almost everything
it touches.
That's fluoi'ine for you.
And for over 200 years chemists racked their brains to find some material that
would hold fluorine. Hold it for even a few minutes' study.
Numerous materials — all considered dependably resistant to corrosion — were
tried. Most went up in a flash.
Some few seemed to work, momentarily. But let temperature rise a trifle, or
pressure build uii — or a trace of moisture seep in — then dig out the wreckage and
start over.
Finally nickel and its alloys were tried. They work. They last for months
where other materials failed in days or weeks. Today, j^ou flnd nickel and
Inco nickel alloys in equipment that produces fluorine, in pumps and piping and
valves where fluorine is compressed, stored, and processed. Nickel and Inco
nickel alloys hold fluorine, even under heat and pressure. By the way, if you
would like to know more about fluorine, ask us for a copy of Fluorine Makes Its
Debut.
Wlien you hare a mcial proMem—
If it's corrosion, it can't be any tougher than that caused by fluorine, and the
solution may be found in Inco nickel or one of the Inco nickel alloys. Inco
corrosion engineers are ready to help you. They've prepared a corrosion data
work sheet to make it easy for you to outline your problem to them. Write for it,
without obligation, of coui'se.
Or perhaps your metal problem concerns temperatures — high or low — stresses
or fatigue resistance. AVhatever it may be, Inco engineers will gladly help you
find the answer. The International Nickel Co., Inc., 67 Wall Street, New
York 5, N. Y.
FLUORINE
In contrast to the tendency to iodine deficiency, too much fluorine in the water
supply is detrimental. Fluorine has been shown to be the cause of a disfigur-
ing dental disease known as mottled enamel or fluorosis (1077). Fluorine inter-
feres with the normal calcification of the teeth during the process of their
34 FLUORIDATION OF WATER
formation, so that affected teeth, in addition to being usually discolored and
ugly in appearance, are structurally weak and deteriorate early in life. For
this reason, it is especially important that fluox'ine be avoided during the period
of tooth formation, that is, from birth to the age of 12 years.
Fortunately most of our large city water supplies do not contain toxic con-
centrations of fluorine, but there are sections in Arizona, California, Colorado,
Florida, Idaho, Iowa, Kansas, Minnesota, Mississippi, Montana, Nebraska, New
Mexico, North Dakota, South Dakota, Ohio, Oregon, Texas, Utah, Wisconsin,
Wyoming, Africa, Canada, China, England, Italy, New Zealand, and South
America in which all native-born inhabitants who have used the community
water supply during the period of enamel formation have mottled teeth.
Quantitative knowledge of the human requirement for iodine and the human
tolerance for fluorine has been handicapped by the minuteness of the amount
involved in each case, which causes difficulty in analysis and measurement.
Correlation studies (1070) between the occurrence of mottled enamel and
the fluorine concentration of the water consumed by afflicted persons show
that this dental disease is always found when water containing even as little
as 1 part per million of fluorine is used continuously during the period of
formation of the permanent teeth. Severe mottling of the temporary teeth
(1078) has been repeatedly observed when the fluorine concentration of the
water is excessively high (6 to 16 parts per million). Water containing such
high concentrations of fluorine cannot be safely used even for cooking.
The fluorine content of foodstuffs has been found to vary widely, but no evi-
dence has been advanced so far to show that fluorine as combined naturally
in foods is toxic. The fluorine problem therefore is chiefly concerned with the
need for avoiding water containing fluorine in order to prevent the occurrence
of mottled enamel. In many communities this is difficult, for all available water
is contaminated with fluorine. In the past few years several methods of treat-
ment of water for the removal of fluorine have been investigated, most of them
proving unsatisfactory. The Arizona Agricultural Experiment Station has
recently developed a method (lOfiO) of fluorine removal by filtration, through
the use of specially prepared ground bone, which has proved effective and prac-
tical for reducing the concentration of fluorine below the level that causes the
dental disease. The method is based upon the previously mentioned fact that
fluorine has a chemical affinity for the calcium of bone.
The use of fluorine compounds as spray insecticides (1079) for vegetables and
fruits presents another problem. Tests on rats indicate tliat the compounds of
fluorine studied were equal in toxicity and that cryolite, a fluorine compound
commonly used as a spray insecticide, was just as effective as the more soluble
fluorine compounds in producing mild mottled enamel. Government control of
the use of these compounds is recommended as a means of prevention of fluorosis,
although the question of exact tolerance level for fluorine spray residues on
food materials merits further investigation.
[United States Dispensatory, 24th edition, 1943, pp. 1456-1457]
Fluorides
Absolute hydrogen fluoride is at temperatures below 19.4° a clear, volatile
liquid, miscible with water. Commercial hydrofluoric acid usually contains about
46 to 50 percent of HF. Because of its solvent properties on glass, hydrofluoric
acid is stored in lead, paraffin, or bakelite containers. Its vapors are extremely
irritant and on contact with the skin cause serious ulcerations. If inhaled, they
may cause edema of the glottis and death. In dilute solution, hydrofluoric acid
act's, like other acids, as a local irritant, but is much more destructive to
epithelium.
Hydrofluoric acid is u.sed for cleaning metals but especially for etching
glass. (Balance of paragraph describes this use.)
Fluorides, especially sodium fluoride, have had some experimental use in
medicine, Goldenburg" (Semana mediea, 1932, 39, 1639) recommended sodium
fluoride in the treatment of exophthalmic goiter ; he used it either by mouth or
intravenously. The salt has also been used in rheumatism and in epilepsy. The
dose employed has been from 10 to 60 mg. (approximately one-sixth of 1 grain).
Fluorides are violent poison to all living tissues because of their precipitation
of calcium. When introduced into the mammalian circulation, they cause fall
of blood pressure, respiratory failure, and general paralysis. Continuous in-
FLUORIDATION OF WATER 35
gestion of nonfatal doses, according to Sollniann (J. Pharmacol, 1921, 17, 197),
cause general cachexia and permanent inhihitioii of growth. It is well estab-
lished that the condition characterized by mottled enamel of the teeth endemic
in ceitain areas — notably the Mississippi Valley — is due to the presence of small
auiDunts of tiuorides in tlie drinlving water. For methods of removing fluorides
from drinking water, see Funk and Lindsay (Ind. Chem. Eng., 1936, 28,
947), lOlvove (Pub H.'alth Report, 1937, 52, 1308), and Dean (Pub. Health Report,
1939, r)4, 802).
In lower animals, analogous changes occur in teeth and the bones become
hard and fragile (Cristiana, compt. rend. soc. biol., 1927, 9(j, 843). On the other
hand, it appears that cnmpiete absence of tiuorides in drinking water, particularly
during the first 10 years of life, may cause dental caries. Carefully controlled
exp'rinu-^nts in regiilating the lluoride content of driid^ing water of several com-
munities will, in the next few years, estal)lish whether there is need for the
element and, if so. the optimum concentration for it.
Sodium fluoride solutions, in concentrations ranging from 0.05 to 2.0 percent,
have been applied topically in the treatment of teeth with seemingly good re-
sults. Fntil their value is established, however, the use of fluoride-containing
dentifrices or interna! medicaments is not justified. For an excellent review on
this subject, authorized by the Council on D^ital Therapeutics of the American
Dental Association, see Jay (J. A. Ph. A., Prac. Ed., 1946, 7, 204).
TOXICOLOGY
In human ca.ses of aciite fluoride poisoning, the most common symptoms
are epigastric pain, nausea, vomiting, diarrhea with frequent local paralysis
either in the legs or face. Necropsy shows congested and edematoiis mucous
membrane of the stomach and upiter bowel, often with scattered hemorrhages.
As the chief cause of death is the inactivation of the bodily calcium, the most
imiiortant factor in the treatment is the free administration of lime salts; lime-
water by mouth will help by precipitating any fluoride which may be in the
stomach and calcium chloride intravenously is useful to supply a systemic
deficiency.
For records of human poisoning, see Sharkey and Simpson (J. A. M. A., 1933,
100. 97). As little as 0.25 gm. of sodium fluoride has caused dangerous symp-
toms. Many of the cases of human poisoning have occurred from ingestion
of a fluoride roach poison in mist: ike for baking powder.
Under the name of ammonium bifluoride, a solution containing 20 percent of
ammoiiiam hydrogen fluoride and 10 percent of hydrofluoric acid has been used
by Head (J. A. M. A., 1931, 61. 2233) in the treatment of pyorrhea alveolaris.
This solution is actively germacidal, having a phenol coefficient of 5.82. Several
fluorides — ammonium, potassium, and sodium — have found various nonmedical
use as, for example, in insecticides, in cleaning compositions, as fluxes, and as
mordants in dyeing.
Sodium silicofluoride, also knov.n as sodium fluosilicate Na2SiF6, is a white
granular powder soluble in 150 parts of water. Since the fluosilicates possess
the toxic properties of the fluorides, this salt is largely used as an insect exter-
minator and rat poison.
FLUORINE
F. (19.00). — Fluorine, the most active member of the group of halogen ele-
ments, was discovered in 1771 by Scheele, who obtained it from fluorite. but it
was not until 1886 that Moissan succeeded in separating it and studying its
properties. It is a green gas with a specific gravity, compared with air, of 1.31.
Fluorine can be liquefied lielow its critical temperature of -129° ; the liquid
boils, under atmospheric pressure, at -187°. The density of the liquid is 1.14.
It is the most strongly negative element known, and hence is highly reactive.
An account of fluorine produced by electrolysis if a mixture of anhydrous hydro-
fluoric acid and fused patassium bifluoride is presented by Porter (Chem. Met.
Eng. 1946, July, 106).
The Chairman. The Chair would like to call attention again to the
fact that Ave have a large number of witnesses, and if the time taken
by the others is as long as those who have testified, we will not have
an opportunity to hear so many today.
36 FLUORIDATION OF WATER
I would like to say tliat we have just so mucli time and to suggest
that you might like to conserve the time so that as many as possible
can testify.
Our next witness is Mr. Vincent A. Kleinfeld, attorney, of Wash-
ington, D. C.
STATEMENT OF VINCENT A. KLEINFELD, ATTORNEY,
WASHINGTON, D. C.
Mr. Kleinfeld. Mr. Chairman, and members of the committee, my
name is Vincent A. Kleinfeld. I live at G:>03 30th Street ^' W., Wash-
ington, D. C.
Mr. Chairman and members of the committee, I wish to thank the
committee for permitting me to testify in connection with H. R. 2341.
I appear in behalf of the National Citizens Committee on Fluori-
dation, Washington, D. C., and the Florida Statewide Committee
Against Fluoridation, which is an affiliated member of the Pure Water
Association of America. These organizations are opposed to the
fluoridation of the public water supply of this Nation.
First, I should like to set forth briefly my background. The only
reason for doing this is that, unfortunately, in connection with this
problem, as with respect to other problems, there is a growing tend-
ency to call those who disagree with us by opprobious names, rather
than to meet their arguments by better ones. In addition, there is
no doubt that the fluoridation program does create sometimes hysteria
on both sides of the fence. On one side you Avill find those opposing
fluoridation talking about some fantastic Communist plot. Of course,
that is nonsense.
On the other side, you will find the proponents of the program say-
ing that fluoridation will not only reduce the incidence of dental decay
in children but actually will improve the appearance of their teeth.
And these very people, a number of years ago, by the use of photo-
graphs and statistics and figures, showed that in the cities where they
had about 1 part of fluoride added to the drinking water, about 10
percent of the children were having what they called a very mild
mottled, or spots on their teeth. They were in the back and sometimes
in the front.
I am not saying that is very bad. I am saying that they claim that
it was an improvement in the appearance of their teeth. So I will try
here not to become hysterical about it. My main purpose in this tes-
timony is to say that the advocates of fluoridation in the water supply
of the entire Nation are proceeding in somewhat an unrealistic and
certainly an indecent eflEort.
My background generally is this : I am a private lawyer, practicing
law in this city. For approximately 10 years, I was head of the unit
of the Department of Justice which handled litigation under the
Federal Food, Drug and Cosmetic Act and similar regulatory
statutes. I have written books in that field ; I teach in the field and
I have written fairly substantially in the field.
For approximately 3 years, I was chief counsel to the House of
Representatives committee to investigate the use of chemicals in foods
and cosmetics and it was that committee, 2 members of which were
physicians, 1 of whom was a former State health officer, which held
hearings on the fluoridation of j)nblic water and issued a report on the
FLUORIDATION OF WATER 37
subject, House Report 2500, 82d Congress, 2cl session. This report
concludes as follows, and I quote :
The Surgeon General of the United States Public Health Service testified be-
fore the committee as. follows ou the problems created by the ever-increasing
utilization of chemicals in our food supiily —
and I quote his statement:
"The contamination of air, water, food, and milk with chemicals and the
resultant effect ou health is of concern to the Public Health Service. The rapid-
ity with which new compounds are being introduced in the production, process-
ing, storage, packaging, and distribution of foods is alarming, particularly in
view of tiie fact that the toxic effects of so many of these chemicals and the
compounds which they form when introduced into the food are unknown. Be-
cause of the fact that many individuals in the United States are exposed each
day to these potential hazards, the Public Health Service wholeheartedly en-
dorses the study which the committee is undertaking."
I continue now with the quotation from the report of the committee :
In the opinion of your committee, the fluoridation of the public drinking water
of a signiticant portion of the population of the Nation is an integral part of
the problem adverted to by the Surgeon General. Water is consumed by every
person in a community, regardless of his age, physical condition, or possible
personal reactions. It is essential, therefore, that all the facts concerning
fluoridation be disseminated, and an opportunity given to the people of each
community to decide for themselves whether they desire to assume, at this time,
the calculated risk inherent in the program.
The committee is of the view that a sufficient number of unanswered
questions concerning the safety of this program exists as to warrant a con-
servative attitude. The committee believes that if communities are to make a
mistake in reaching a decision on whether to fluoridate their public drinking
water, it is preferable to err on the side of caution. This would seem to be
particularly true since there are reasonable alternatives to fluoridating the
public water supply, even if these alternatives are not quite as effective. The
topical application of fluorides to the teeth of children may be more cumber-
some, and perhaps more expensive than the simple addition of fluorine to
drinking water. Nevertheless, it is a feasible program and one which will
provide comparable protection for children's teeth for the period needed to
acquire evidence beyond a reasonable doubt that no hazard exists to any
portion of the population by reason of the addition of fluorides to drinking
water.
The advisability of fluoridating the public water supply of the Nation is
essentially a local problem, to be determined for itself by each community.
Your committee is not recommending that Federal legislation be enacted in
this field. The committee strongly urges, however, that research now under
way be continued and expanded and that further studies, not limited to an
examination of the vital statistics, be conducted to determine the long-range
effects upon the aged and chronically ill of the ingestion of water containing
inorganic fluorides.
The point may be raised at the outset as to the constitutional power of the
Federal Government to prohibit agencies of the States and cities from fluori-
dating their drinking water supply if they so desire. I believe, personally, that
point is well taken. If the Congress deems it advisable, however, it can
undoubtedly provide that no agencies of the Federal Government, including the
governments of the Territories and possessions of the United States, and of
the District of Columbia, shall treat their public water supply with fluorides.
Certainly, what the Congress does and what this committee does will have a
most persuasive effect upon the States.
I believe also that the point may be well taken, that this committee cannot
substitute its judgment on scientific questions for that held by medical and
scientific authorities. I firmly believe, nevertheless, that this committee is well
qualified to determine if there is a split of authority on whether the fluoridation
program has been proven afiirmatively to be entirely safe to all segments of
the population, and to act accordingly within the authority vested in the
Federal Government.
In this connection, it is highly significant that a substantial number of
reputable scientists hold the view that not enough is yet known about the
38 FLUORIDATION OF WATER
cumulative and variable systemic effects of fluorides to warrant introducinj,^
them into our drinking water, which every person must necessarily consume,
including- the young and old, the sick and well, the undernourished or mal-
nourished child, and those with allergies or idiosyncrasies. If this committee
determines that a prima facie case is developed indicating that a problem may
exist, the committee may wish to hold further and more extensive hearings —
or may wish to say that, in its opinion, the Federal Government, in the District
of rolumbia or the Territories, in its opinion, is going too far, and that we
should wait.
Certainly the problem is a most important one — no program of this
magnitude has ever been instituted on a compulsory basis as far as I
liave been able to determine. The closest analogy is the program
sponsored by tlie Public Health Service about 20 years ago to add
an iodide to public water supplies to prevent goiter. I do not know
why that program was abandoned. As the situation stands now,
however, those who wish to consume an iodide may do so by using salt
to which an iodide has been added. Those who do not wish to con-
sume an iodide may purchase salt which is free from iodine. I suggest
most respectfully that the committee give consideration to the hear-
ings of the Select Committee of the House of Representatives to which
I have adverted dealing with fluoridation, part 3, beginning on page
1483.
Another indication of what is attempted to be done by legislation
by way of compulsion is a bill frequently introduced in the Congress to
require all salt to be iodized. That has been defeated. Those who
wish to use salt that is iodized can purchase it. Those who do not
want to use it do not have to.
A little over 20 years ago it was discovered that in certain areas
of the country the presence of natural fluorine in the drinking water
caused a mottling of the teeth but reduced the incidence of dental
decay in persons in these areas. The United States Public Health
Service came to the conclusion that if limited amounts of a fluoride
were added to the drinking water of communities wdiose water did not
contain a natural fluoride, there would be little or no mottling and an
approximate two-thirds decrease in the incidence of dental decay.
The Public Health Service has issued an unqualified endorsement of
the program and, in a booklet entitled "Better Health for 5 to 14
Cents a Year Through Fluoridated Water," and otherwise, is en-
couraging cities to adopt the program. There is no doubt that most
of the major organizations of the country in the field of health and
medicine are of the opinion that the addition to communal water sup-
plies of fluorides, in the proportion of about one part per million, does
not present a health hazard. It is also clear, however, that a minority
view is held by a number of qualified scientists, who believe that the
safety of this procedure has not been demonstrated beyond a reason-
able doubt. It is their position that the proponents of fluoridation,
most of whom have done no independent research, are proceeding far
too rapidly in recommending that communities fluoridate their water
supplies immediately.
I have set forth a few of the divided scientific opinions. For exam-
ple. Dr. F. J. McLure, biochemist at the National Institute of Dental
Research, Bethesda, Md., has said this :
In view of the evidence we have accumulated and in consideration of the exten-
sive studies of other authorities in this field, we do not regard the fluoridation
of drinking water as a public health hazard.
FLUORIDATION OF WATER 39
On the other hand, Dr. V. O. Hnrme, D. D. S., director of clinical
research, Forsyth Dental Infirmary for Children, Boston, has said:
As yet there is not enough scientific basis for reconimonding immediate accept-
ance of proposals to treat entire populations with fluorides.
Dr. R. S. Harris of the Massachusetts Institute of Technology, has
said :
* * * considerably more research on the toxicity of fluorine should be con-
ducted before this' interesting means for reducing tooth decay in man is
extended.
There seems to be little dispute that children ^Yho, from birth to t]ie
age of 8, consume water containing approximately one part per million
of a fluoride, will have fewer cavities than children drinking water
containing no fluoride. The major problem vrhicli exists, however, is
whether a suflicient amount of scientific investigation has been per-
formed to warrant adding fluorides to the entire water supply of the
Nation now.
It is the natural tendency of most people, and that of many of our
great newspapers, to advocate most earnestly the fluoridation (»f our
drinking water. I certainly do not blame them for, as I have indi-
cated, most of our associations devoted to health have endorsed i:hc
program.
It is most important, however, to determine which approach to the
problem of adding a fluoride to drinking water, or adding any cJiem-
ical to any food substance, is taken. Most of the advocates of the
program say, and this may well be true, that it has not been estab-
lished that the addition of a fluoride to water has killed or injured
anyone. Therefore, they declare, the program should be adopted tince
the incidence of dental decay in children will be reduced. A])parently
that is the position held by the Public Health Service, based on that
proposition and so-called epidemiological studies.
The other approach is that taken by the Food and Drug Adminis-
tration, another Bureau of the Department of Health, Education, and
Welfare, not to the fluoridation progi-am, but to the overall problem
of the addition of chemicals to the food supply of the Nation. The
firm view of the Food and Drug Administration in connection with the
addition of any chemical to any food is that it is up to the proponent
of the utilization of a new chemical to demonstrate its safety bej^ond a
reasonable doubt, and that is not up to the public or the Government
to establish that it may present a hazard. That position is held by the
Food and Drug Administration with respect to the addition of a chem-
ical to any food even if, as distinguished from water, the public may
choose to consume the food or to leave it alone. This approach is most
important, for frequently there may be some suspicion of hazard cau:-ed
by a chemical, althougli this cannot be proven either by a preponder-
ance of the evidence or beyond a reasonable doubt.
It is the view of the Food and Drug Administration, nevertheless,
that it is up to the proponents of the chemical to establish by com])re-
hensive scientific data that the suspicion is unsound. This position
was firmly set forth by the former Commissioner of the Food and Drug
Administration as follows :
I feel that no new chemical or no chemical that is subject to any question
as to safety should be employed until its possible injurious effect, both on an
acute and on a long-time chronic basis, has been shown to be nonexistent. In
40 FLUORIDATION OF WATER
other words, any chemical that is proposed for use ought to be proved in
advance of distribution in a food product to be utterly and completely vpithout
the possibility of human injury.
The same general stand was taken by the council on foods and
nutrition of the American Medical Association with respect to cer-
tain surface-active compounds which were being employed in bread
and various other foods. The council said that :
Unless the complete harmlessness of these agents can be demonstrated beyond
a reasonable doubt, they should not, in the council's opinion, be employed in
basic foods.
Subsequently, after protracted hearings, the Food and Drug Ad-
ministration refused to permit the use of these substances in bakery
products, notwithstanding that it had never been definitely estab-
lished that the substances would cause harm to humans; and this
decision was affirmed by the courts.
There is no dispute that fluorine is an extremely toxic element.
But it is equally clear that tests of the character advocated by many
scientists and organizations dealing with the- public health with re-
spect to the addition of chemicals to foods, have not been conducted
on animals with water to which a fluoride has been added. It ap-
pears to be true that the kidneys of the ordinary person in good
health will excrete almost all of the fluoride ingested through fluori-
dated water. However, exhaustive research does not appear to have
been conducted dealing with the effect of fluorine if consumed by
those — and there are many of them in this country — who have im-
l^aired kidneys. It has been reported that the fluoride content of pla-
cental tissue taken from women residing in an area which fluoridates
its water was considerably higher than the fluoride content of placen-
tal tissue from women residing in an area whose water supply contains
merely trace amounts of fluorine. It is not definitely known how
much, if any, of the fluorine passes to the fetus, or whether or not
it is harmful to the child.
The proponents of fluorine have admitted that they rely heavily
upon epidemiological studies and analyses of the vital statistics of
communities which have had a natural fluoride in their drinking
water for many years to prove that inhabitants of such areas are
not afflicted with any greater numbers of illnesses than persons from
nonfluoride areas.
In an epidemiological study, all observations are related to the
group and it is the group statistics which control. This type of
study is contrasted with a clinical study, in which the observation
remains related to the particular individual under study. There are
many scientists who believe that epidemiological studies and analyses
of vital statistics cannot be relied upon to conclude with certainty
whether the physical condition of particular persons, such as those
with kidney trouble, would or would not be worsened by fluoridated
water.
It is important to realize that substances have been used for many
years on the assumption that they were completely safe because it
liad not been established in advance that they were toxic, and yet it
was subsequently determined that a hazard to health did in fact
exist.
A few examples are pertinent to indicate the danger of relying
upon vital statistics or upon studies which do not take into considera-
FLUORIDATION OF WATER 41
tion differing ages, idiosyncrasies and physical conditions. You may
recall a salt substitute containing lithium chloride which was in use
for some time. It had not been believed to be unsafe, and it was
fairly widely used. It was subsequently discovered that to some
few persons on a low salt diet, lithium chloride was extremely toxic,
and salt substitutes containing lithium chloride were thereupon re-
moved from the market.
Coumarin was used for 75 years as an ingredient of some imitation
vanilla flavors and as a fixative and base for other synthetic food
flavors. These flavors were consumed in ice cream, baked goods, and
other products. Very recently, pharmaceutical studies revealed com-
prehensive evidence of the capacity of Coumarin to produce damage
to the liver of experimental animals, and it is no longer used in food
products.
Dulcin, a syntlietic sweetening agent, was widely used for 50 years.
No investigation of its possible adverse effects when consumed daily
in small amounts over a long period of time was conducted until a
few years ago, when the Food and Drug Administration studied the
problem.
Previous toxicity studies had been content to show that no imme-
diate ill effects were noted in either man or animals from quantities
such as would be used for sweetening food. The Food and Drug
Administration's study of the chronic toxicity of Dulcin extended over
2 years. It consisted of incorporating Dulcin into the diet of rats
and observing the effects on growth and survival throughout their
lifetime. After death, the various organs were examined miscro-
scopically to see what pathological changes had taken place. The
data revealed that Dulcin was toxic, and it was removed from our food
su])ply.
Within the last few years, it was discovered that certain cases of
serious blood disorders and death were associated with the adminis-
tration of the antibiotic Chloromycetin. It was only after these deaths
that it was determined that Chloromycetin should not be used indis-
criminately for minor ailments, and that when employed, periodic
blood checks should be made.
It was discovered fairly recently, also, that a limited number of
persons reacted most adversely to penicillin and terramycin, other
of the wonder drugs. This does not mean, of course, that the use of
these drugs should be discontinued. It means only that they should
be used when really needed, and only under the most careful medical
supervision.
Another example of the fact that long epidemiological studies do
not necessarily establish freedom from hazard is found in the use
of certain theretofore approved coal-tar dyes used in coloring foods.
These dyes were employed for many years.
Only very recently studies by the Division of Pharmacology of the
Food and Drug Administration revealed evidence of serious chronic
toxicity in animals, and a hearing has been held by the agency which
will presumably result in the outlawing of these colors from future
use in our food supply.
In other words, gentlemen, "safety by assumption," based entirely
on long usage or on studies of vital statistics, would by no means
appear to be conclusive from a scientific viewpoint. The subtle, in-
42 FLUORIDATION OF WATER
sidioiis effects of a chemical, particularly a highly toxic substance such
as fluorine, on a limited number of specific persons with various
chronic disorders, particularly when consumed every day for many
years, may not be readily recoanized. In fact, as indicated, this may
be the situation even where great precautions are taken and the
substance is consumed under medical supervision.
I respectfully suggest that this be compared with the fact that
every single person in the city of Washington, young or old, sick
or well, without any regard to personal allergies or peculiar reactions,
must necessarily consume a fluoride with every drop of water he
drinks.
As stated, the epidemiological studies by the Public Health Service
revealed no unusual incidence of chronic disease in the naturally
fluoridated areas of the United States. To repeat, however, there is
no deiinite knowledge as to the possible long-term effects, particularly
on adults and children with kidney trouble, and on malnourished
children. For example, an article in the February 1952 issue of the
American Dental Association entitled "Relation of Endemic Dental
Fluorosis to Malnutrition," had this to say :
Importance of investigations of nutritional status : The data from tliis and
other investigations suggest that malnourished infants and children, especially
if deficient in calcium intake, may suffer from the effects of water containing
fluorine while healthy children would remain unaffected. It is possible that the
small proportion of individuals who show some, though slight, endemic dental
fluorosis in communities with only about one part per million of fluorine in the
water supply do so because of insufficient intake of calcium or because of
disturbances in calcium metabolism.
Thus low levels of fluoride ingestion which are generally considered to be safe
for the general population may not be safe for malnourished infants and children.
Therefore the nutritional status must be carefully assessed and guarded in areas
with endemic fluorosis. Nutritional studies should be included in any compre-
hensive program of fluoridation of water, with special attention to clironically
ailing infants and children.
One of the oldest and best known dental research institutions in
this country is the Forsvth Dental Infirmary in Boston. Its clinical
research director is Dr. Veikko Oscar Hurme. Dr. Hurme has pointed
out that fluoridation is mass medication, undertaken without any-
thing approaching adequate knowledge of the effect of fluorides, or
the widely varying tolerances of young and old, sick and well.
The professor emeritus of biochemistry of the University of Wis-
consin stated that —
the toxic limit is a tremendously important matter and when we find commu-
nities ingesting a fluorine content such as indicated and nevertheless have gotten
along well and apparently have had no recorded pathology, yet we wonder how
well controlled was the examination and whether there is not something after
all that did develop that we do not know anything about.
The director of the nutritional biochemistry laboratories of the
department of food technology, Massachusetts Institute of Tech-
nology, has testified that the scientific literature does not establish
that the continued ingestion of fluorine to the extent of one part per
million in water is harmless; that that literature does not adequately
answer many pertinent questions; and that in his opinion consider-
ably more research on the toxicity of fluorine should be conducted
before that method of reducing tooth decay is extended.
In order to test on a communitywide basis the effects of adding
fluorides to water, a series of pilot programs were inaugurated. Not-
FLUORIDATION OF WATER 43
withstanding that these programs have not been conchuled, encourage-
ment is being given to hundreds of cities to act now rather than await
the conchision of the programs. Furthermore, and tliis is most impor-
tant, no comprehensive study is apparently being made in these pilot
programs of the effect of fluoridated drinking water on adults or the
aged who may be suffering from impaired kidney function oi- other
chronic diseases.
There are those who believe that there may be some hazard but
who are frank in admitting that they are willing to take what they
call a calculated risk.
The following statement of Dr. Francis C. Heyroth, representing
the National Research Council ad hoc committee on fluoridation of
water supplies, is pertinent in this connection :
Question. Is it not true, Doctor, that you can live without sugar, and I suppose,
witliout sodium chloride or salt, but you have got to have water?
Dr. IIeykoth. That is right.
Question. So if a person in the District of Columbia is suffering from kidney
trouble, I think your advice would be not to drink water.
Di". IIeyroth. Xo, the advice would be to drink some water that comes from a
mineral spring that is free from fluorides, which could be done. This man is
very sick, you see, and that is a prescription for him.
Question. That is what.he would have to do — he would have to get his water
privately elsewhere?
Dr. IIeyroth. He would if it can be established that he is going to be sick
for the rest of his life, which I doubt very much. He is either going to improve
his kidney function and then that question is no longer pertinent, or else he is
going to die, and then it is no longer pertinent.
Question. Doctor, in your report to the city of Cincinnati dated January 26,
1951, on page 8, you say this :
"About 1946, workers of the United States Public Health Service expressed
the opinion that fluoridation should not be undertaken until epidemiological
data comparable in reliability to those secured in regard to the incidence of
caries and mottled enamel had been obtained on the health of old i>eople who
had lived for long periods in areas of known high and low fluoride concentra-
tions in the drinking water. Unfortunately, such data have not been provided
except to a very limited extent."
Is it not important that such data be provided?
Dr. Heyroth. I think it is. I put it in this report for the purpose of stimulating
that sort of work.
Question. But you did recommend fluoridation?
Dr. Heyroth. Yes, I did recommend fluoridation.
You see, we have a calculated risk. Whenever one has to make any decision
of this sort — shall we or shall we not put fluorides in water — we have to see what
is the risk on both sides. If we put it in, I think the risk of doing any systemic
damage to the aged and so on is very, very remote. If we leave it out, we know
what the risk is in regard to the dental caries that we are not going to eliminate
in children.
It is most interesting to note that Dr. Heyroth recommended that
the city of Cincinnati fluoridates its water supply notwithstanding his
own opinion that there were a number of health questions which had
not been answered definitively. Obviously, Dr. Heyroth, and there
are others, who are perfectly honestly willing to take this calculated
risk because it seems to them to be a slight risk. But there are numer-
ous others, both scientists and laymen, who do not believe that such
a risk should be taken with literally millions of peo])le of all ages
and varying degrees of health. Particularly do these latter people feel
that these risks should not be taken since there is no indication what-
ever that dental decay, disagreeable though it may be, causes serious
48391 — 54 4
44 FLUORIDATION OF WATER
impairment to health or sliorteiis life, or that one who suffers from
dental decay may infest or injure his neig-hbors.
Similarly, there are others who are willing to take a "calculated
risk" with the mottling of teeth frequently caused even by slight addi-
tions of a fluoride to drinking water. Thus, a i-epresentative of the
Association of State and Territorial Health Officers stated that:
If I had to choose between 10 percent of the community's children having mild
mottling and 88 percent of them having extensive caries I would unhesitatingly
choose the mottling. And I have no doubt that I speak for all the State health
oflScers in making that choice. For that matter, as a father of two appearance-
conscious teen-agers, I have no hesitation in making the same choice. Nor, they
assure me, would they.
Certainly no one can quarrel with a personal decision of that char-
acter. The short answer, nevertheless, is that other parents may feel
equally strongly that they would rather take the risk of a few caries
in their children's teeth, than the hazard of even slight mottling of
their teeth.
Gentlemen, this brings up another problem which is of fundamental
importance, and that is the rights of an individual in a democracy such
as ours. It is perhaps an old-fasliioned notion that people, even if
they are in a minority, have a right to be let alone. The adherents of
this school of thought hold the view that our democratic tradition de-
mands a respect for the privacy of the individual — a respect for the
desire of the individual to be let alone even if he is in a minority and
notwithstanding that most people may think he is wrong.
.There are many thousands of people in this country who do not
want either themselves or their parents or children to consume a
fluoride every day of their lives. They believe that they can protect
the teeth of their children in many other ways — by topical fluoridation
which presents no danger and which has been strongly endorsed by the
Public Health Service; by periodic vists to their dentists; by seeing
to it that their children brush their teeth regularly and do not con-
sume large quantities of sweets and carbonated beverages.
It is true that the rights of the individual sometimes have to be
subjugated to the rights of the majority, particularly where there is
danger to health and the possibility of hazard to others. Persons who
are not vaccinated may contract smallpox, become disfigured, and die.
In addition, and even more important, they may infect their neigh-
bors. The impelling concept that the community health must be pro-
tected requires that the wishes of the individual, including even those
of persons who may suffer some adverse reaction, be submerged and
subordinated.
Even so, it is a physician who administers the medication and ob-
serves the patient. Fluoridated water, however, must be consumed
by all of us, and without the interposition or supervision of our doc-
tor or dentist. In addition, we will not infect the community if we do
not drink fluoridated water. Those who wish to give their children
a fluoride — and they are entitled to hold that opinion — can do so
readily by the use of fluoride tablets. The wishes of those who do not
desire their children to consume fluorides, and seek to rely on other
methods of reducing dental decay, should be equally respected.
Another example is the chlorination of public drinking water. We
must chlorinate our water to prevent disease and perhaps epidemics.
FLUORIDATION OF WATER 45
Here, arain, the rights of the iiKlivi(hial must give way to those of the
conimiinity. In any event, it is interesting to note that chlorine may
be removed, by those who so desire, by heating the water, and that
chlorine, as distinguished from fluorine, has no physiological effects
upon the body.
There is no doubt that the fluoridation progi-am constitutes medica-
tion, and medication which all of us must accept. The therm "dnig"
is defined, in part, in section 201 (g) of the Federal Food, Drug, and
Cosmetic Act, as articles intended for use in the diagnosis, cure, miti-
o-ation, treatment, or prevention of disease in man or other animals,
and articles intended to affect the structure of any function of the
body of man or other animals.
Medicine deals with the prevention, cure, and alleviation of disease.
A reduction of the incidence of dental disease is the aim of fluorida-
tion. It is safe to say that fluoridation is mass medication without
parallel in the history of medicine. An analogy is vaccination, which
is designed to prevent smallpox and not to treat persons who are
afficted with the disease.
I should like to conclude by quoting from the message of the Presi-
dent to the Congress in January of this year. This is what the
President said, in part :
Freedom, consent, and individual responsibility are fundamentals to our
system in the field of medical care. This means that the traditional relationship
of the physicians and his patient, and the right of the individual to select
freely the manner of his care in illness, must be preserved.
I suggest, gentlemen, that the parents of this community and other
communities should have the right to have their children treated
with fluoridated water or otherwise as they so desire.
The Chaieman. Are there any questions?
If not, we thank you, Mr. Kleinfeld, for your appearance. We
realize that you have given a great deal of time in the preparation of
the statement which you have made to the committee today, and we ap-
preciate having the benefit of it in the consideration of this subject.
We thank you.
Mr. Kleinfeld. Thank you, sir.
The Chairmax. The committee will adjourn until 2 o'clock.
(Thereupon, at 12 : 30 p. m., a recess was taken until 2 p. m. of the
same day.)
AFTERNOON SESSION
The Chairman. The committee will please come to order.
Congressman Philbin has called my attention to the fact that Miss
Florence Birmingham, president of the Massachusetts Women's
Political Club is in the room and that she has an engagement that
requires her to leave early, and I will hear from Miss Birmingham at
this time.
STATEMENT OF MISS FLORENCE BIRMINGHAM, PRESIDENT,
MASSACHUSETTS WOMEN'S POLITICAL CLUB, BOSTON, MASS.
Miss Bir:mingiiam. Thank you very much, Mr. Chairman. I am
the president of the Massachusetts Women's Political Club, a non-
partisan, nonsectarian oroanization, representing approximately
60,0(10 women in that State.^
46 FLUORIDATION OF WATER
For a good many years we have been fighting against fluoridation
in the public water supply and, therefore, I have come here to put
this organization on record against fluoridation, and in favor of the
principle contained in this billH. R. 2341,
I should like to ask unanimous consent that my remarks be extended
in the record.
The Chairmak. You certainly will have that privilege. I have had
handed to me your statement on behalf of the organization that you
represent, and while I have not had the opportunity to read it in full,
yet I can see j^ou have given a great deal of attention to the study and
we appreciate having the beneflt of the views that you have expressed.
There have been several Members of Congress who have spoken
to me with reference to your interest in the subject and I might say
to you that when you come here with Congressmen like Philip J.
Philbin, who is so outstanding, you are in good company.
Miss BiR3iixGiiAM. Thank you very much, Mr. Chairman. Con-
gressman Philbin is an honorary member of our organization.
The Chairman. You are honored in having him represent you.
Miss Birmingham. Thank you very much. We feel that way.
(The statement of Miss Birmingham follows:)
Statement by Miss Florence Birmingham, President, Massachusetts
Women's Political Club
The Massachusetts Women'?; Political Club is a nonpartisan, nonsectarian
organization, dedicated to teacliing women tlie need for good government and
educating them how best to use their political power and strength. It is over
30 years old. As its president, I am here to place our organization on record
against fluoridation of water supplies and thus in favor of H. R. 2341.
For the past several years we have been engaged in fighting fluoridation as a
'threat to our liberty in that it is mass medication "without parallel in the
history of medicine." The battle has been long and arduous as the Public
Health Department, backed by generous funds allotted to it by the Congress,
iias pushed fluoridation with a savage ferocity.
When I was appointed trustee of Wrentham State School for Feebleminded
Children, I learned there quite by accident that fluorine was used in the water
supply. A trustee takes a solemn oath before the Governor and council. There-
fore, I felt obligated to study this subject very carefully in order that the children
might be protected. Many of them are State wards who have nobody else to-
look out for their interests.
I mentioned my fears to the board of trustees and told them that in our
organization we had studied the Menace to Health of Fluorine published by the
Univerity of New Mexico in 1938 and knew fluoridation was harmfui. The
trustees requested me to investigate and inform them of my findings. I studied
both sides of the fiuoridation issue. It took me a long time to fit the pieces
together in the fluoridation scheme at the institution, for information was
given most reluctantly.
Although the section of the law governing certain powers and duties of trus-
tees states, "All trustees shall have free access to all books, records, and accounts
pertaining to their respective State hospitals," I could learn nothing of the-
fluoridation experiment in progress there.
Dr. William D. Welock, director, division of dental health, of the Massachu-
setts Department of Public Health, referred me to a special report, in reply to
my query asking why, of all institutions, schools for the feebleminded children-
should 1 e chosen. This report of 1045 mentioned Department of Mental Health
In?titutions. A subsequent report, he said, named Wrentham State School, the
Belchertown State School, and the Fernald State School as selected studies for
the fluoridation of water supplies in this State. However, this report like so
many key documents was out of print, I was told.
In" the fourth annual conference. State dental directors with the Public Health.
Service and the Children's Bureau held in the Federal Security Building. Wash-
ington, D. C, in .lune 1951, Dr. John W. Knutson, Chief of Dental Public Health,.
FLUORIDATION OF WATER 47
stated frankly that the Public Health Service did not get around to approving
water tluoridation until 5 years later. And yet they imposed tins upon the little
helpless wards of the State, not only in Massachusetts but in other parts of the
Nation such as the State school in Southbury, Conn.
In that year studies were begun in selected areas throughout the country, all
under the jurisdiction of the Federal Government.
Dr. Frank Bull, of Wisconsin, in the fourth annual conference explained "Inci-
dentally, we never had any experiments in AVisconsin. To take a city of 100,000
and say, "We are going to experiment on you, and if you survive we will learn
something' — that is kind of rough treatment on the public. In Wisconsin, we
set up demonstrations. They weren't experiments."
In :>lassachusetts, they were studies.
The trustees voted to halt tluoridation, but to my shocked surprise we were
told by the department that it was not an experiment and the fluoridation con-
tinues on. And I still knew nothing specific about the setup at the school. How-
■ever, I intensified my efforts to awaken the public to the threat to our liberty
inherent in the program.
Natural water is a right the individual can expect from his municipality. In
the use of that right no individual should be obliged to take a preventive medi-
cine, especially when that medicine is a rat poison for which there is no known
antidote.
Sodium fluoride is made from scrap aluminum. This former waste product is
bringing in millions of dollars to the chemical companies and machinery
manufacturers.
As an American citizen, I was frightened when I saw the "iron curtain" of
secrecy surrounding every phase of the fluoridation scheme. All the more so
when i found in the files a letter revealing that Dr. Wellock, of the Public Health
Department, had come to the institution school and in a conference with admin-
istrative officials warned them there should be no publicity on the fluorine pro-
gram there. In other words, I should not be enlightened.
We maintain that if this had been a bona fide ethical and true scientific
arrangement, those who instigated fluoridation in the school would not have
feared explaining it to the trustees who represent the public. The shroud of
secrecy was terrifying to nie, especially when it cloaked up an experiment upon
feebleminded wards of the State who should have been treated with mcn-e scrupu-
lous cai-e, if anything, because of their pathetic condition. Many of these little
children live out their lives in the institution and are buried in the graveyard
on its grounds with none but the angels to \\eep for them.
Archbishop Richard J. Gushing, of Boston, has said that such little children
were put into the world to make us kinder and more gentle, for they are close to
the saints.
It was not until January 1953 that I learned about the experiment. It came
through a book published by the Department of Public Health, called Common-
wealth, given to me by a medical doctor who condemns fluoridation. Fluorida-
tion was established in two schools of the feebleminded as a result of studies
being carried on in various parts of the country. Wrentham and Belchertown
State schools were fluoridated and became the pilot, but Fernald was maintained
as the control station — no fluorides being added to the water there.
"Similar studies," said the senior sanitary engineer, "have been conducted
on a citywide basis at Newburgh, N. Y. with the neighboring city of Kingston
serving as a control. In Michigan, Grand Rapids undertook a similar study with
Muskegon, the neighbor city, acting as the nonparticipating guide. O er a (j-
year period a reduction of nearly 50 percent in tooth decay has already been
noted among children of Grand Rapids and Newburgh.
Dr. P.uU of Wisconsin told the dental officers from all over the Nation bluntly
that the statistics gathered by the prefluoridation survey among elementary
school — an essential step in mining a local propaganda field — are for the only
purpose of building up the fluoridation program in any local area. To these
dental health directors from all over the country he said. "Now why should
we do a prefluoridation survey? Is it to find out if fluoridation works? No.
We have told the public it works. So we cannot go back on that."
Moreover, in contradiction of the sanitary engineer's statement Grand Rapids
was no longer paired off with Muskegon. On page 1500 of the hearings before
the special congressional committee investigating fluoridation Dr. Bruce D.
Forsyth said, "I believe this. We should continue to go back each year and
study Grand Rapids population as we have been doing. We can even go back
48 FLUORIDATION OF WATER
to Muskegon although we have lost our control city there. They felt they
wanted the water fluoridated and so it is being fluoridated, and so we have
lost it as a control. But we certainly want to go back each year and do re-
examination."
In such perfectly childish language Dr. Forsyth confessed the loss of the con-
trol, which it was convenient to lose, a blunder for which a scientist can never
be forgiven.
The CIO Union, local number 396, at Wrentham State School, publicly pro-
tested fluoridation of water supplies and experimentation on human beings
without their consent. The union president said : "We told the board of trustees
and the superintendent that we strongly objected to being used as guinea pigs
in this experiment which the administration at the institution now admits openly
in the press was put into effect as an experiment. But they do nothing to
stop it.
"We object to wild claims being made as to its benefits, so-called, at the insti-
tution ; we object to the fact that it is not only a slow poison which can cause-
grave illness and death, but it is still being used no matter how we object. We
protest to the lack of understanding of our concern and worry which has to
our knowledge affected the health of employees mentally and physically.
"The method used in putting fluorine in the water at the State school is
enough to cause panic at the institution among employees.
"Every employee at the school knows that the engineer has nothing to do
with. A boy patient does it, and the electrician drives him to the watershed, or
pumping station for the school, which is about 3 miles from the institution.
This working patient is an assistant to the electrician, who is not an engineer.
"I had a long conversation with this working patient who goes to the water
station almost every day. He knows what it is, for he said, 'Come up with
me and I can show you how I can take care of you if I get mad at you. Your life
is in my hands now.'
"There is no fence around the building or pumping station where they put in.
the fluorine. In fact, no fence for miles around. Anybody could poison the
whole institution. There are no warning signs at all. Imagine what could
happen if some of the boys escaped, and not knowing that this is rat poison,
broke into the watershed and threw fluorine about."
Yet the administration stated publicly they were not consulted when the De-
partment of Public Health decided to launch the experiment.
This statement brings us back again to the United States Public Health De-
partment which has pushed this experiment by use of taxpayers' money without
the consent of citizens who stand helpless before the combined power of the
Federal Treasury, equipment concerns, and the chemical industry.
The special congressional committee of the Congress, in Report No. 2500, on
fluoridation of public drinking water, advised communities to go slow on fluor-
idation, but did not recommend Federal legislation.
We deem siich legislation necessary as the Public Health Department inso-
lently shrugged off the recommendations of the committee, and through its cen-
tralized agencies has used its vast resources to place fluorine in the drinlving
water without even informing the citizens. This was done in Salem and Beverly
in Massachusetts where fluorine was polluting the water months before they were
aware of it.
The Public Health Department is flouting the food and drug laws. In Massa-
chusetts Mr. Cyril C. Sullivan, former Chief Inspector of the Food and Drug Ad-
ministration for New England, until his retirement from Federal service, de-
tected a small amount of fluorides being added to beer and ale as a preservative ;
that is to stop afterfermentation in the bottle. The amount added was so small
that it could scarcely be detec-ted by chemical analysis of the product, being less
than 0.5 part per million. The case came up for trial and the court and jury
found defendants guilty. They held that the offense was of such a serious char-
acter that the defendant corporation of Springfield was fined $5,000, and the de-
fendant personally was also fined $5,000 and in addition, a jail sentence of 6
months was imposed and suspended, and the defendant was placed on probation
for a period of 3 years. (See JJ. S. v. Commonwealth Brewing Co., D. C. Mass.
1945).
The same procedure should be followed in the case of fluorine in water supplies.
Since the Food and Drug Administration is now winking at the violation of whole-
sale fluoridation, a legislation must be enacted to correct the situation. H. R.
2341 should be passed as an emergency measure.
FLUORIDATION OF WATER 49
If this mass experimentation upon liunian beings is not ended, then the com-
plete dignity of man will be lost in the totalitarian mass medication fraud and
the end will' be wholesale adoption of euthanasia and death by the needle for the
weakly and unwanted. Fluoridation is the opening wedge. The January issue
of Red Book magazine quotes an anonymous "highly respectable" physician as
confessing to putting people out of the way. "I think," he says, "that mercy
killing undoubtedly goes on more frequently than many of us would believe * * *
To some it is murder whatever the circumstances * * * And murder, we know,
is wrong * * * Mercy killings will go on, whatever we try to do about it."
In Loudon the needle is being talked about as a new method of execution. The
issue is being raised, "Would doctors who agree to administer a death injection
be breaking the Hippocratic oath which every doctor swears at the outset of his
career?"
The oath declares, "I will give no deadly drug to any though it be asked of me
nor will I counsel such * * *."
We may ask, "Does a doctor advocating addition of fluorine, a most powerful
rat and roach poison for which there is no known antidote, to drinking water
break the Oath of Hippocrates which he also has to take?" We believe he does.
The passage of this legislation would solve this problem and safeguard the
citizens' liberty and health. We pray that this committee will act favorably upon
H. R. 2341.
Re Chonological history of the fluoridation hoax or Operation Rat
Poison in Three Installments.
To Members of the General Court:
It is time we were calling a spade a spade. The more research we do, the
more corrupt this whole fluoridation scheme appears. Several public-spirited
citizens have helped us compile and print three installments giving the entire
history and purpose of the fluoridation hoax. The first installment enclosed is
the longest and outlines the chronological history of it. The two shorter install-
ments to follow will give substantiating proof of the facts as outlined in this
installment.
These articles should serve to awaken our State legislature to the fact that
this fluoridation problem is more important than new highways, new taxes, or
new hospitals.
When all the insidious ramiflcations of this mass medication scheme are
known to the public, its true significance will make the Teapot Dome scandal of
30 years ago appear picayune by comparison. The latter was an illicit profit
for a few and its scandal is said to have killed only one — a President. Fluori-
dation is heavy commercial profit for a few but entails the destruction of human
tissues, health, life, and the constitutional rights of millions.
If the legislature should fail in its duty to the public, it will necessitate the
bringing of this whole sordid mess directly to the people in each local community
affected.
Now, as never before, we need men and women like those of our colonial days
who stood resolutely for that which was right even though it meant opposing
the autocratic power of the crown.
]\Iassachusetts Women's Political Club,
Florence Birmingham, President.
Part I. Fli:okidation a Hoax or Opebation Rat Poison
Fluoridation is a deceitful and illegal sales promotion of a deadly poison by
a Government agency. It is more repugnant politically than "taxation without
representation." It is more insidiously devastating than communism in Govern-
ment. It is more destructive to our populous than crime or juvenile delin-
quency. It is slow creeping mass murder for a profit and it is as illegal as
murder. It is a colossal fraud because it takes the public's money without
giving in return any scientifically proven therapeutic value. All claims of
benefit to children's teeth are based on unproven, misconstrued, misinterpreted,
and superficial facts.
The wi-iters hereof can and shall prove each and every statement above if
the reader will read this and further installments.
The truth about fluoridation has been and still is being suppressed. How else
have so many cities been able to pour this "rat poison" into the city water
supply without the knowledge of the citizens who are forced to drink it? If
50 FLUORIDATION OF WATER
there is any doubt in your mind tliat sodium ilouride, the substance they pro-
pose to put in our pure New England water is a poison, see the United States
Dispensatory, the official medical compendium 24th edition, page 1465, available
in your drugstore. It reads, "Fluorides are violent poisons to all living tissue
because of their precipitation of calcium. They cause fall of blood pressure,
respiratory failure, and general paralysis."
Why is it tliat you can question at random 100 people in any city now using
fluoridated water and find none that know the truth about it, only a few that
know they are drinking it, and those that did see a little notice in the paper
had heard only that it was good for their kiddies' teeth?
How and why have they l)een able to dose the water supply of over S37 American
communities serving 1.5,500.000 people with this rat nnd cockroach poison and
yet have it brought to popular vote in only ('0 conununitiesV In 40 of these 60
communities where a semblance of publicity was forced by a few irate citizens,
it was roundly defeated. In the other 20, only one side of the issue was given
the unsuspecting public. How 15,500,000 intelligent Americans liave become
docile guinea pigs to a mass medical experiment with a deadly poison is unques-
tionably the colossal hoax of the century. Just how was this possible? It
couldn't have been done 100 years ago when we had a Government of the people,
b.v the people, and for the people.
It can and has happened here — and will continiie its nefarious progress imless
the public learns the truth. Lincoln said "if this Nation is ever destroyed it
will be destroyed by enemies from within, not from without."
Yes, dear citizen, you are witnessing the price we pay by our apathetic attitude
of "let George do it" or "what can I do, I'm only one little guy"? Wlien the
people lose interest, the overlords expand their power until eventually we
become helpless vassals. It has already happened to 10 percent of our popula-
tion, who have been sold a bill of goods with every effort made to keep the truth
from them as we shall prove herein.
WHAT IS THIS FLUORinATION CRAZE?
A high pressure sales campaign on the part of the United States Government
agency to illegally impose mass medication of an unsuspecting and uninformed
public, by using the prestige of a Government department to control press releases,
influence dental associations, local health departments, and PTA's. That same
agency has distributed, postage free, at taxpayers' expense, tons of propaganda
blinding the taxpayer to the truth. Every high-pressure sales trick in the book
has been used to get the equipment installed and the poison poured into the
drinking water with a minimum of publicity and before those v^-ho take a sincere
interest in their community could put up a roadblock. This mass medication has
been done in violation of Federal laws, of State laws, and of our constitutional
rights. It has been done under conditions of duress, withoiit our knowledge or
consent, and with no reasonable chance to escape. (See article on Legal Aspects
of Fluoridation.) Furthermore, fluoridation aside from its legal aspects is a
crime against the laws of God and man.
FACTS IN THE EVOLUTION OF OPERATION RAT POISON
The chronological history
First step. — Dr. George W. Heard, a dentist of Hereford, Tex., some 30 years
ago announced that the soil in Deaf Smith County was so rich in minerals that
there was hardly a toothache in the county. Twenty-three years later, other
dentists investigated and came away with the erroneous conclusion that it might
be due to the fluorine in the water, since its concentration seemed high.
As against this conclusion, Dr. Heard himself says :
"With this I do not concur. Fluorine in water is a deadly poison, inorganic,
and cannot be properly assimilated b.v the human organism. It is purely an
inorganic drug. Fluorine in soil and water is not a food, but plant life grown in
this soil converts this mineral, which is a poison, into food values which prevent
disease."
Taber's Cyclopedic Medical Dictionary bears out Dr. Heard's contention : "All
such mineral elements must first be absorbed by plantlife and taken into the
animal body as food before they can be assimilated."
Dr. Heard also states that in spite of the fluorine in the water which is the
same today as 30 years ago, the percent of decay in the teeth in Hereford today
FLUORIDATION OF WATER 51
is 40 percent. This would certainly tend to indicate that it was not fluorine but
our increased use of refined foods that is the real culprit behind decayed teeth.
(Excerpts from report to City Council, San Bruno, Calif., which report helped
to defeat fluoridation.)
Second step. — Sodium fluoride is a poisonous byproduct of the aluminum and
the fertilizer industries. Like all companies efiicient management strives for
the profitable use of all byproducts. Up until recently the only commercial uses
for sodium fluoride were as rat and cockroach poisons but these used only a
small proportion of the output.
Its disposition created quite a problem. They were not permitted to dump it
into rivers for it would poison the fishes and users downstream. When it was
dumped into fields, the vegetation grown near it killed animals. What to do?
Apparently someone conceived the brilliant idea of taking advantage of the
erroneous conclusions drawn from Deaf Smith County, Tex. The Aluminum
Company of America then began selling sodium fluoride tablets to put in
the drinking water to prevent dental caries in children 6 to 16 years. In their
magazine ads they suggested that readers write them for full information
about having the city fathers add fluorine to the city water supply. But
this method must have proved too slow for the campaign was soon stepped up
with a vengeance.
2'hird step. — In 1&44 Oscar Ewing was put on the payroll of the Aluminum
Company of America, as attorney, at an annual salary of $750,000. This fact
was established at a Senate hearing and became a part of the Congressional
Record. Since the Aluminum Co. had no big litigation pending at the time, the
question might logically be asked, why such a large fee? A few months there-
after Mr. Ewing was made Federal Security Administrator with the announce-
ment that he was taking a big salary cut in order to serve his country. As head
of the Federal Security Agency (now the Department of Health, Education,
and Welfare) he immediately started the ball rolling to sell "rat poison" by the
ton instead of in dime packages. How?
By using the pressure of the Federal Government he induced the city fathers
of Newburgh, N. Y., Grand Rapids, Mich., and Evanston, 111., to try a 10-year
experiment with fluoridation "to actually determine the effects of this 'rat
poison' upon the dental caries of growing children." This was in 1945. The
Nurenberg trials against Nazi criminals for experimenting on humans started in
1946.
Thus we see the paradox in which one Department of the Government is prose-
cuting 23 Nazis as arch criminals for illegally experimenting on human beings
without their consent. In said trials the fact that humans were used as
"experimental" guinea pigs outraged the conscience of the civilized world as
being a crime against the fundamental laws of God and the inalienable rights
of man. Some were hanged, others received long time sentences. But, at about
this same time, we see another department of our Government (leli))erately
committing the same illegal criminal act en masse against its own people in the
name of "medical therapeutics."
Fourth step. — But was Mr. Ewing content to await the 10-year duration of
the experiment? No — rat poison must be sold. Besides, the word "experi-
ment" had by this time become distasteful. Possibly they figured that the best
defense is ollVnsc, so to connt^Tuct this criminal charge of "mass experimenta-
tion" they put pressure everywhere to boost the sales of "rat poison" just as if
it were a foregone conclusion that experimental work was not necessary. Nev-
ertheless, it most certainly was an experiment and was so recognized in a letter
by the United States Public Health Service and by the Delaney congressional
committee investigating the fluoridation of public drinking water. But, like
the Nazi experiments on human guinea pigs, it most certainly was not "scientific."
In reality it was a sales promotion scheme. More appropriately, it should
be called an experiment of expediency to sell sodium fluoride (rat poison) under
the utterly unsubstantiated guise of helping dental caries in the youngsters.
At this point let us emphasize that "thei'e is no true scientific evidence to show
that children's teeth are actually benefited by sodium fluorine being dumped
into the water, despite all tlie pseudo testimony given before the Delaney com-
mittee by the profluoridators, as we shall prove later. The claim of 50 per-
cent reduction of dental caries positively cannot be scientifically substantiated.
Local health authorities, parent-teachers associations, local and national dental
associations were all approached by the stooges of the master salesman, Ewing.
In a letter to Michael Ambrose, Ewing insists that fluoridation "should be pushed
52 FLUORIDATION OF WATER
vigorously." Thus, with the backing of tlie United States Government, and
millions of the taxpayers' money to spend on unsubstantiated and unscientific
propaganda, such a sales promotion program would give even rat poison the
flavor of bon-bons and the smell of Chanel No. 5. Is it any wonder that local
city and town officials were swept off their feet and felt sure they could be doing
no wrong by imposing this mass medication experiment on the unsuspecting and
iminformed pul)lic. After all, wasn't the United States Government urging it?
Let us digress to remind these local officials that the Nazi war criminals also
thought they were doing no wrong. They pleaded that the orders came from "the
highest possible German authority" — others pleaded pressxire from above or that
the experiments were for the ultimate ))enefit of der vaterland, or that they did
it for the scientijfic advancement of all mankind. Nevertheless the judges and an
enraged world opinion decided that the experiments were in no sense scientific but
were in reality political expediency and that they violated the fundamental God-
given rights of free individuals, that such rights could not be abrogated by anyone
under any conditions. Result — the rope tightened about their necks. Once our
people learn the real truth atiout Operation Rat Poison there might well be some
necktie parties over here. Such predicaments develop only where men sacrifice
principle for expediency.
Fifth step. — In 1952 it was hoped by thousands of thinking people that a change
in the administration would put an end to this illegal mass medication experi-
ment with rat poison. We should have known better. We should have known
that once anyone joins an illegal racket you just don't quit at will. Things had
gone too far. The public had been kept in the dark. The perpetrators of this
poison scheme were safe. Rat poison sales had jumped. Dental associations,
PTA's, and city fathers had been sucked in by innuendos, half truths, and un-
scientific statements. They had had too much faith in the utterly fallacioiis
principle of the infallibility of Government. They believed what they were told
solely because of who was telling them, and not because of factual scientific
evidence.
So, regardless of what our hopes were when Mrs. Oveta Hobby took over the
Federal Security Agency, and regardess of how good her intentions may have
been, she too was caught in the whirlpool from which there was no escape. Over-
night her agency became a full-fledged department known as Health, Education,
and Welfare and she gained full Cabinet status. But what doomed the hopes of
the antifluoridators was when they saw Mr. Nelson Rockefeller appointed as
Mrs. Hobby's assistant with the title of Under Secretary. The Rockefellers own
or control the aluminum trust, chemical fertilizers, and drug syndicates. They
wield abject control over more authoritative medical research than any single
group in the world through the instrument of the Rockefeller Foundation. Col-
leges and universities are beholden to it for millions in grants. If any ex-
perimenter to whom the Rockefeller Foundation has donated turns up evidence
that helps sell Rockefeller chemicals, the chances are good that they will re-
ceive another grant. They control the news releases by controlling millions in
advertising. Newspapers avoid bucking them for fear of financial advertising
reprisals.
So Operation Rat Poison goes merrily on in high gear. For .5 years the United
States Public Health Service, a division of this department had not been too
enthusiastic about fluoridation and actually opposed it. But, overnight that has
changed and now they give their blessing. Did they obtain long drawn-out ex-
perimental evidence overnight, or did they receive orders from above? Most cer-
tainly scientific evidence is not so quickly obtained. So, now with the United
States Health Service openly pushing fluoridation Operation Rat Poison is mak-
ing wonderful strides wherever the whole truth is not told to the public. Sub-
stantiating proof for above, to follow in next installment.
Re second installment of fluoridation hoax.
To the Members of the Oeneral Court:
As promised we offer herewith the second installment of operation rat poison.
This one gives the substantiating scientific proof to the bold statement made
in the first installment ; namely, that the profluoridators have positively no con-
clusive scientific proof of their contention that the adding of sodium fluoride
to the drinking water can in any way help the teeth of children.
The sources given herein are authentic and many are from unimpeachable
scientific data made before the selfish sale of rat poison became a Government
political football.
FLUORIDATION OF WATER 53
We .give duta from Funk and \Va,i:iialls, the ITnited States Department of Agri-
■cultnre Yearbook 1939 (before Kwinii), the University of Mexico and Arizona
find doctors operating in that area where Uuoriue has been a problem fcjr years ;
\also statements of medical men made when the scientific truth was more im-
portant than i)oltical expediency.
Our legislators certainly realize that with political backing many sufticient
pseudotruths can be broadcast that will fool all who do not take the time to
investigate. We are all victims of such propaganda as regards fluorine. We are
not getting the scientitic truth. As Senator Miller put it, he was convinced that
one presumed authoritative source was simply repeating the other, with none
having done any scientific work and each feeling safe because it had a Govern-
ment agency's blessing — a modern version of '"the king can do no wrong."
Massachusetts Women's Political Club,
FLOitENCE Birmingham, President.
Part II. Fluoridation, a Hoax or Operation Rat Poison
PROOF OF CLAIMS MADE IN PART I
A poison
Section 20703 of the Health and Safety Code of tlie State of California defines
fluorides soluble in water as poison.
Section 2(»751 makes it unlawful to vend, sell, give away, or furnish either
directly or indirectly any poison enumerated in section 20703 without a poison
label.
The Massachusetts Legislature owes it to the people of Massachusetts to pass
a law that will prohibit the poisoning and polluting of our water. The law should
be made specific to counteract the propaganda of the United States Department
of Health whose authority apparently changes the universal chemical action of
God-made elements.
Here is some testimony before the Delaney House Investigating Committee:
'•Dr. Miller: 'If you told people you put rat poison in water to cure (dental)
•caries it might raise several eyebrows.'
"Dr. Alfred Taylor, Ph. D. : 'After all it is a fact, that's about the only way
that you can bring home the fact — I know of no other chemicals used in food or
drink which is toxic enough to be u.sed as a practical poison.' "
Dental aspects
Tlie United States Department of Agriculture Yearbook 1939, Food and Life :
"Fluorine has been shown to be the cause of a disfiguring dental disease known
as mottled enamel or fluorosis. Fluorine interferes with normal calcification of
teeth during the process of their formation, .so that teeth, in addition to being
unusually discolored and ugly in appearance, are structurally weak and deterio-
rate early in life. For this reason it is especially important that fluorine be
avoided * * *."
Funk & Wagnalls New Standard Dictionary gives the following definition :
"Fluorosis, a disease coming from the ingestion of too much fluorine, is a well-
■established toxicological entity, characterized by increased fragility of bones,
due to their atrophy, and interestingly enough by enamel defects in teeth,
•exposing them to early decay."
Thus we see that fluorine produces the very opposite effect to that which
fluorine added to drinking water is supposed to achieve. Chemical inorganic
fluorine must not be contused witli the fluorine that nature has organized into
food. Chemical inorganic fluorine tends to harden the teetli to a point where
they become very brittle and later crumble. This early unnatural hardening
process has been misinterpreted by profluoridators as reducing tooth decay in
childi-en. Those dentists who are avidly encouraging fluoridation to help the
kiddies teeth will find in years to come those same teeth will ci'umble under
the grinding machine and tliey* will be unable to do tlieir usual excellent job.
Demarious C. Badger, M. D., pediatrician, of Hobbs, N. Mex., which is in a
fluorine area, says :
"It is my opinion that if fluorine is in drinking water to the extent of seven-
tenths parts per million that a fair majority of eliildren will develop a defect
in their permanent teeth, providing this water is ingested in the first 6 years
•of life. I have formed this opinion because I live in an endemic area of dental
fluorosis where fluorine content is one part per million. I have gone over the
54 FLUORIDATION OF WATER
school children who have been born and raised here, and have fovind that
about 35 percent of the children have a moderate defect in their permanent
teeth."
This was a personal communication from Dr. Badger to Mrs. Golda Franzen,
San Francisco, Calif. Dr. Badger continues:
"If the level of fluorine is above 0.7 part per million, then children under 3
years of age, and preferably under 6, should use Altered or distilled water in
order to prevent a defect in their permanent teeth, which are forming during
these years."
It should be noted that the proposed concentration of fluorides in our Massa-
chusetts water is to be one part per million, or above the level set by Dr. Badger.
Dr. M. C. Smith and Prof. H. V. Smith, University of Arizona, Tucson, in.
Observations on Durability of Mottled Enamel :
"To one who is familiar with the disfiguring dental defect known as mottled
enamel, which affects the teeth of every person who drinks water containing
as little as one part per million of fluorine during the years of tooth formation,
this recommendation seems, to put it mildly, unsafe.
"There is ample evidence that mottled teeth, though they be somewhat more
resistant to the onset of decay, are structurally weak, and that unfortunately
when decay does set in, the result is often disastrous. The chart graphically
represents the result of a survey of the situation in St. David, Ariz. The survey
includes the adult group so that a truer picture of the durability of mottled teeth
could be obtained."
Dr. Max Ginns, senior consultant on the staff of Worcester (Mass.) City Hos-
pital, a graduate of Tufts College Dental School and a practicing dentist since
1914, made some personal investigations. He was first an advocate of fluorida-
tion. After visiting the fluorine areas he said :
"The enormous amount of tooth decay and crooked teeth so shocked me that I
then began to question all of the propai^anda al)out beneflts of fluoridation.
My disillusionment with the entire fluoridation program was complete when I
learned that in these areas people were drinking Osarka (spring) water to avoid
mottling and decay." — Boston Traveler, July 1, 19.">2.
Medical aspects
Qualified medical men and scientists make the following statement regarding
fluorine :
"Increases fragility of bones."— Dr. Gutnian, M. D.
"Disastrous effect upon goiter." — G. Steyn, South African Medical Journal,
printed in New Bedford, Mass., Standard-Times, March 11, I'.KjI.
"Hardening of the arteries ; gastrointestinal disturbances : disorders of the
respiratory system ; disorders of the cardiac system." — Dr. IMcLester, M. D.
"Brittle bones." — Taber's Cyclopedic Medical Dictionary.
"Mottling and discoloration of teeth ; pitting of enamel ; spotty baldness in
young men ; decrease in clotting power of blood ; anemia ; interferes with trans-
missions of nerve impulses ; affects metabolism of carbohydrates, fats, and pro-
teins."—Dr. Jonathan Forman, B. A., M. D., F. A. C. A., head of Ohio State Medi-
cal Association.
"Lethal ingredient in rat poison." — C. R. Wells, American Dental Association.
"Increases sterility ; decreases the birthrate." — Dr. J. Larner, M. D.
"Dr. Alfred Taylor, Ph. D., one of the leading research scientists of the
Nation, found that fluoridated water in a concentration of one part per million
did shorten the life span of mice destined to die of cancer. It did cause a con-
sistent increase in death rate of hatching eggs. As a result of these findings,
26 Te as cities have held u]) plans for fluoridating." — Personal communication
from Dr. Alfred Taylor to Mrs. Marion E. Lyon.
Dr. Leo Spira, M. D., Ph. D., who has spent 2.5 years of clinical investigations
regarding fluorine poisoning and fluoridation of man and experimental research
on animals, many of whose scientific reports havQ been printed in various pub-
lications writes :
"Fluorine is a highly toxic substance, and its deleterious effect consists of de-
priving the body of calcium stored in the body as a material indispensable for
sustaining the vitality of most of the organic functions.
"You no doubt realize that even the 70-90 percent of fiuorines are not elim-
inated without first doing damage to the body. This amount of fluorine has
passed through the entire body, and has affected every tissue before it has
eliminated, mainly through the kidneys. The 10-30 percent of fluorine re-
tained exert a cumulative action on the body."
FLUORIDATION OF WATER 55
"It is true, these quantities (amouuts used in fluoridation) are not sufficient
to produce acute fluorine poisoning and kill tlie victim witliin liours of in^^estion ;
but, owing to the cumulative nature of the poison, that is to say, owln.u to the
fact that some of the poison ingested is retained in the body, a time will come
when the tissues are irreparably damaged. This means a slow, gradual death.
"Grand Rapids, Mich., the only city which has had artiticial fiuoridatiou for
more than 4 years, showed the following signilicaut facts: Deaths from heart
disease and it's complications increased from 585 in 1944 as compared with 1,031
in 1949. The deaths from nephritis (kidney disease) and intracranial lesions
both increased 50 percent in the 4-year period. The population increase, however,
was only 7.8 percent. A new method of tabulating deaths was inaugurated in
1949, so'that flgures beyond that are not applicable."
Fluorine versus chlorine aspects
To the layman who might ask, "If they can put chlorine in the Vvater, why can't
they put fluorine?" Chlorine is put in the water as a police power to protect the
public from contamination due to germs. Fluorine on the other hand is not put
in to protect the public as a whole, but as a therapeutic agent in the hope that
it will help dental caries in certain ages of children. Chlorine is used to treat the
^-ater — fluorine is used to treat the human being. Therefore fluorine is medica-
tion. Worse than that, it is mass medication, though admittedly it is only
claimed to be l)eneficial to a small group of youngsters. Why poison the entire
population when those who wish fluorine for dental purposes can use it in pill
form for their water. Actually the painting of the teeth by your dentist with
a compound of fluorine will do more good tliau the injection of fluorine into the
body and this is not mass medication. It is not criminal and is not illegal.
Re Operation Rat Poison, Third Installment.
To the Members of the General Court:
This the third installment gives the bold truth about one of the most colossal
sales frauds in history.
Read how, in a Government office of that department supposed to be dedicated
to the protection of the health of the American people, a massive sales meeting
was held to put over Operation, Rat Poison. The fuller minutes of this meeting,
from which we quote a few excerpts gave not one single shred of scientific proof
that adding fluorine is beneficial but it does emphatically state that the pro-
fluoridators get the job done witliout public discussion ; without letting it come
to i)ublic vote and with giving the public one side only.
Read how they secretly admit they don't know the answers, but it enough of
the right statements are made to enough of the right susceptible people by a Gov-
ernment authority anything can be put over.
Read how they violated the fundamental precepts of our Founding Fathers to
the effect that education of the masses to their prolilems is the basis of all sound
democratic government.
Read how they taught their fieldworkers : (1) not let the public know the
truth; (2) avoid letting the people know that sodium fluoride is a poison;
(•3) that they don't know the answer to the toxicity questions: (4) that they
should put it over on the dentists, and the PTA organizations before they can
learn the real truth or organize resistance.
If ever in this country's history we need men of the caliber of John and Samuel
Adams, John Hancock, Thomas Jefferson, and Abe Lincoln, it is now. As never
before, we need statesmen who will stand for principles rather than politicians
who think only of expediency. Massachusetts furnished the statesmen who
sparked the movement that created our country. Will she again furnish the
men who will act to show other States that statesman.ship is not dead?
Massachusetts Women's Political Club,
Florence Birmingham, President.
Part III. Fluoridation a Hoax or Operation Rat Poison
secrecy and half truths as propaganda
Lincoln said, "Give the people the truth and they will save the Nation."
This principle is the foundation of American democracy and the strength of
our Nation but the extreme opposite was adopted by the Federal Security Agency
under Oscar Ewing and unfortunately is continuing today. Mr. Swing's propa-
ganda expert was Edward L. Bernays. We quote from Dr. Paul Manning's arti-
56 FLUORIDATION OF WATER
cle : The Federal Engineering of Consent. Nephew of Sigmund Fi-evid. Vienna-
born Mr. Bernays is well documented in the Faxon book published in 1951 (Rum-
ford Press, Concord, N. H. ) ; Public Relations, Edward L. Beruays and the
American Scene :
"The conscious and intelligent manipulation of the organized habits and opin-
ions of the masses must be done by experts, the public relations counsels (Ber-
nays invented the term) ; they are the invisible rulers who control the destinies
of millions.
"* * * file most direct way to reach the mind of the herd is through its leaders.
For, if the group leaders accept our ideas, the group they dominate will respond.
"In a talk to public-health-education leaders by Bernays, thought-control
methods were introduced. 'A united leadershiji must eliminate lags by the engi-
neering of consent. You, as a leader must get people to follow you. You must
gain their consent to your health programs by gaining their support through
many types of persuasion. But all this must be planned ; indoctrination must be
subtle. It should be worked into the everyday life of the people — 24 hours a day
in hundreds of ways. Public-health officers cannot afford the professional
modesty professed by physicians.'
"A redefinition of ethics is necessary. * * * The subject matter of the propa-
ganda need not necessarily be true, says Bernays."
COMMENT
The layman, the citizen, the PTA member, the doctor, the dentist, the city
fathers of our towns, and members of the State legislature should reread the
above for those are the words of a man who has been directing the fluoridation
program. His words are diametrically opposed to that of Jefferson and Lincoln
and of everything that maintains democracy. It is this philosophy that is today
pouring rat poison into the bodies of 15 million American citizens.
Our public-spirited patriotic legislators should stop this "hoax" by specific
legal action designating the word "fluorides." As long as the people are apathetic,
what can you expect from a democracy but totalitarianism?
To demonstrate still further the lack of scientific knowledge, the use of high-
pressure sales methods, and the desires to keep the public in the dark with regard
to fluoridation, we quote excerpts from the fourth annual conference, State
Dental Directors with the Public Health Service and the Children's Bureau, held
June 6 to 8, 1951, in the Federal Security Building, Washington, D. C. Chairman :
Dr. John W. Knutson, Chief, Division of Dental Public Health Relations and co-
chairman Dr. John T. Fulton, Dental Service Adviser, United States Children's
Bureau.
For the sake of brevity we quote only a sentence here and there :
Dr. Knutson : "As you all know, the Public Health Service did not get around
to approving water fluoridation until 5 years later (1950). You all know that
Dr. Frank Bull has appeared before us, and also dental groups during the past
5 years, asking the simple question, 'What are we waiting for? Why don't we
go ahead and fluoridate water supplies?' "
Dr. Bull, who was salesman deluxe for rat poison in Wisconsin, "What are
some of the objections?"
"The first: Isn't fluoride the thing that caused mottled enamel? N^ow we tell
them this, that at one part per million dental fluorosis bring about the most beau-
tiful teeth that anyone ever had. And we show them pictures of such teeth. We
don't try to say that there is no such thing as fluorosis even at 1.2 per '.million
which we are recommending, but you have got to have an answer. iMaybe you
have a better one."
Author's comment : The reader should please note that in this liigh-pressure
sales meeting the recognized sales head, Dr. Bull, never gave his underlings the
ans^^■er to any of the public's questions nor any scientific evidence to substantiate
the benefits of fiuoridation.
Dr. Bull : "And, incidentally, we never use the term 'artificial fluoridation.'
There is something about that term that means a phony. We call it 'controlled
fluoridation.' Ineidently, we never had any 'experiments' in Wisconsin. To
take a city of 100,000 and say, 'We are going to experiment on you, and if you
survive we will learn something from it,' that is kind of rough treatment on the
public. In Wisconsin we set up demonstrations — they weren't experiments."
Dr. Bull : "Now, in regard to toxicity, I notice that Dr. Bane used the term
'adding sodium fluoride.' We never do that. That is rat poison. You add
FLUORIDATION OF WATER 57
fluorides. Never miiul that sodium-fluoride busiuess. All of these things give
the opposition something to pick at and they have got enough to pick out without
giving them more. But this toxicity question is a dilheult one. I can't give you
the answ er on it. I can prove to you that we do not know the answer to that
one, because we had a city of 18,000 people which was fluoridating its water for
6 to S months. Then a campaign was started by an organized opposition on the
ground of toxicity. It ended up in a referendum and they threw out fluorine."
Dr. Bull : "I don't believe you can win approval of any public health program
where there is organized opposition. I mean, clever, well-thought-up opposition.
So, when you get the answer on the question of toxicity please write me at once,
because I would like to know."
Dr. Bull again : "One thing that is a little hard to handle is the charge that
flouridation is not needed. They talk of other methods and when they get
through adding up all the percentages of decay that we can reduce by such
methods, we end up in a minus. When they take us at our word, they make awful
liars out of us — the research workers."
Author's comment : Thus we see that the arch salesman who put over fluorida-
tion in most of Wisconsin had no facts or figiu-es. He did not know any answers,
but did know how to put over high-pressure salesmanship providing the public
was kept in the dark. Poor Abe Lincoln must have groaned in his grave when
this was said in a Government propaganda meeting in a Government oflice.
Dr. Bull again : "People are going to say, 'Isn't it a fact that you don't know
all about fluoridation? Do you know how this thing works"/' We say, we don't
know all about anything."
Dr. Bull : "You have got to get a policy that says, 'do if * * * What kind of
public health program is it if you say to the community, 'If you want to do it'."
Dr. Bull : "When we are having the press in. and the public in. don't have any-
body on the program who is going to go ahead and oppose us because he wants
to study it some more."
Dr. Bull : "Now, where dentists do not seem interested, do not let them stymie
you — what we do on occasion like this is to arrange for the PTA or some group
to ask for some of us to come in and talk about fluoridation. In this way you get
in without forcing yourself, and you can build a Are under the dentist. This is
promotional work."
Dr. Bull : "You have got to knock their objections down. The question of
toxicity is on the same order. Lay off it all together, just pass it over."
Dr. Bull : "Let me tell you that the PTA is a honey when it comes to fluorida-
tion. Give them all you've got."
Dr. Bull : "If you can, I say if you can, because 5 times we have not been able
to do it, keep fluoridation from going to a referendum — at the same time, do not
tell the people that you are just starting on the fluoridation program in order to
promote something else because you are never going to promote anything that
comes up to fluoridation in an urban community."
Dr. Glover Jones, Texas, interrupts Dr. Bull with : "We have some 30 or 40
cities discussing fluoridation. Various ones had procured equipment and were
thinking and talking about it. The University of Texas had a research pro-
gram on some white mice. There was a rumor that fluoridation of water sup-
plies caused cancer ; that has knocked the pins from under us."
Dr. Bull : "I wish I knew the answer. I do not know why they didn't include
a letter from two-thirds of the deans of dental schools of the University saying
that fluoridation is a rat poison and should not be used. Y"ou know how we
handle it on this 'rat poison' business. We said it was unfortunate it didn't
kill every rat. What do we care what hapisens to rats? You know these re-
search people, they can't get over the feeling that you have to have test tubes
before you start applying it to human beings."
Dr. Bull : "These fellows (research people) can just take the statements of the
ADA, or the USDHS, or the deans of dental schools on research workers and they
can prove to you that we are absolutely crazy for thinking about fluoridation."
Comment : Thus it can be seen that there is nothing scientific, nothing sincere,
no desire to tell the public the truth, no desire to let the public in on it, and every
effort is made in a high-pressure sales campaign to prevent the people from
knowing anything except their one-sided propaganda.
As against all this high pressure, unscientific sales promotional campaign put
on by the Government agency, let us contrast the statement made by Repre-
sentative James J. Delaney, who with 6 other Congressmen including 2 medical
men, heard the scientists from both sides during congressional hearings March
and February 1952. This committee reports :
58 FLUORIDATION OF WATER
"It is essential, therefore, tliat all the facts concerning fluoridation be dissemi-
nated, and an oitportunity be given to the people of each community to decide for
themselves whether they desire to assume at this time, the calculated risk in-
herent in the program. The committee believes that if communities are to make
a mistake in reaching a decision on whether to fluoridate their public drinking
water, it is preferable to err on the side of caution."
You have already been told of Congressman A. L. Miller's testimony before
Congress to the effect that he too was duped and overawed by the force of au-
thorities arrayed in favor of fluoridation. He came out for fluoridation at first
until he started to investigate. Congressman Miller was big enough to admit he
had been duped. Most certainly, every high pressure sales promotion scheme has
been used in Massachusetts by the promoters of Massachusetts medication and
human experimentation. The paramount question now is : Have we today
enough statesmen of integrity with a sincere devotion to their public trust to
withstand this autocratic and undemocratic Government agency? Have we
enough men who can and will think for them.selves instead of listening to those
in authority simply because they are in high Government places? Have we on
Boston's Capitol Hill today Tories who will kowtov/ svibserviently to Government
agencies whether right or wrong or have we patriots as of old who place principle
and the dignity of man above expediency ; and if necessary, above constituted
legal authority?
STATEMENT OF JAMES WATT, MANAGER, WASHINGTON OEEICE OF
THE CHRISTIAN SCIENCE COMMITTEE ON PUBLICATION
The Chairman. Our r.ext witness will be James Watt, manager of
the Washington office of the Christian Science committee on publica-
tions.
You may proceed, Mr. Watt.
Mr. Watt. INIy name is James Watt. I am manager of the Wash-
ington office of the Christian Science committee on publication — part
of the administrative offices of the Christian Science denomination.
I am appearing before this committee today as the official repre-
sentative of the Christian Science denomination, consisting of the First
Church of Christ, Scientist, in Boston, Mass., and its more than 3,000
branch churches. Also, I speak as an individual citizen and as a mem-
ber of the Christian Science Church.
The Christian Science Church and Christian Scientists. individually
protest the compulsory medication, involved in the treatment of public
water supplies with fluorides. We welcome the opportunity to appear
in support of H. R. 2341, and it is our hope that the bill will be favor-
ably considered by the Congress.
In an opinion rendered recently in a Louisiana trial court in the case
of Mark E. Chapman et al v. City of ^hreveport^ which case is now on
appeal, we find this statement concerning fluoridation :
* * * medication, in lay understanding, in condes prophylaxis or preventive
measures, when applied to the individual. * * * Considering the end results that
are sought, we cannot escape the conclusion that it is a form of medication, or
at least a scientific treatment or a sort of hydrotherapy, by way of ingesting
these mineralized waters, of and for the children of the community under 12
years of age.
And further on in his opinion, the trial judge said:
No person or segment of the population having that condition (dental caries or
tooth decay) can on that account have any adverse effect on the health, dental
or otherwise, of the general public or of any segment thereof. We repeat, in
our opinion this is not a matter of the public health. It is strictly within the
realm of individual and personal dental health and hygiene, within which each
person should be free to choose his course for himself and those for whom he is
responsible in tbe family relation. To this field, the just powers of the Govern-
ment do not extend.
FLUORIDATION OF WATER 59
This opinion makes it clear to us that the fluoridation program, as
related to public water supplies, is in effect a step toward state medi-
cine. We are as opposed to state medicine as we would be opposed to
a state church, and for the same reason.
The. constitutional right of the free exercise of religion was made
the very first pronouncement in the Bill of Rights by the Congress of
the United States. The first article of this famous instrument reads
in part :
Congress shall make uo law respet-tiii.Li- an fstalilishnient of religion, or pro-
hibiting the free exercise thereof * * *
For Christian Scientists, at least, this freedom to practice their
religion is being challenged and overrun by the tendency to extend to
medical theories and practices priority over rights of religion. These
practices threaten to undermine one of our beloved country's oldest
and most sacred covenants.
The purposes behind compulsory medication of citizens may appear
worthy. It masquerades as a necessity and a benefit, but actually
represents a form of benevolent despotism which we had hoped for
forefathers swept away a century and a half ago. Therefore, to force
this method of dental hygiene u]:)on Christian Scientists constitutes a
violation of fundamental religious rights.
The Christian Scientists do not oppose any voluntary system of
medicine or surgery or health regimen. They do not desire to impose
their way of thought or healing upon anybody; but they do believe in
voluntary acceptance or rejection of political, religious, or medical
beliefs. It should be stated also that Christian Scientists enter no
objection against measures of sanitation and public cleanliness.
Christian Scientists simply ask that they be permitted to enjoy the
same freedom which, as American citizens supporting the American
way of life, they are trying to sustain for others.
Healing the sick through prayer as Jesus did, and directed His fol-
lowers to do, is a fundamental practice of this Christianly scientific
religion. Christian Scientists know that the right of religious free-
dom is a constitutional right — a right which the majority of people
wish to see preserved. They also know that although their method
of treating the sick by prayer runs contrary to the prevailing sys-
tems of today, it is an integral part of their religion, and, therefore,
a constitutional right. For them it is the most effective known method
for the prevention and treatment of disease, as well as an inseparable
aspect of their worship.
^ They note with alarm the spread of compulsory medical examina-
tion and treatment by institutional and government fiat. There is a
tendency to force healing effort into a single mold, rather than to
rally all the health potentialities of our country and to encourage
them to the highest voluntary effort.
We clo not believe that it is the sense and desire of the electorate,
the legislatures, or the courts of our land to sacrifice religious liberty
in favor of any system of health improvement or control.
In presenting this argument for exemption from compulsory medi-
cal treatment (fluoridation being treatment before the fact — the dis-
ease) Christian Scientists are not challenging the police power of
the state; they are challenging the administration of that power
48S91— 54 5
60 FLUORIDATION OF WATER
insofar as it tramples on religious rights. They are challenging it on
moral grounds — on the moral grounds that forcing medical treat-
ment on persons when it is contrary to their deepest religious con-
victions and practices is a violation of the spirit, if not the letter, of the
first amendment to the Constitution of the United States.
An editorial entitled "Unconscious Tyranny" which appeared in
the Christian Science Monitor of June 11, 1951, states the case suc-
cinctly and reads as follows :
In considering proposals that public water supplies be treated with fluorides
to reduce decay of children's teeth, all that some authorities would require is
that local dental and medical societies and health officials approve. So far as
we know, only the American Water Works Association has added that there
must be a "strong public demand" for such treatment.
This tendency to pass over the people and let the experts decide is all too
frequent these days in matters pertaining to health. It is an attitude of "the
government knows best" that, while well iutentioned, dilutes self-reliant self-
government. Moreover, paternalism involves an unconscious tyranny over indi-
viduals.
Dental health is a private affair, and there are many who prefer to keep the
freedom to decide for themselves how to deal with it. This they cannot do if
public water is medicated as recommended, for then they must either submit
to the fluoride treatment or go thirsty.
Chlorination and fluoridation are not in the same category. The former is
designed to prevent pollution of public water. The latter is an imposition of
treatment that does not relieve a public danger and does deprive individuals
of the choice of rejecting it in favor of another form of treatment. Such aa
intrusion on individual freedom is not to be entered into lightly. In effect, this
is state medicine with the government forcing its concept of dental hygiene
upon everyone in the community. Certainly, no group of experts, however well
qualified they may be technically, is really competent to decide such an issue,
especially when, as in the case with fluoridation, they cannot even agree among
themselves that what is recommended is safe or effective.
A fundamental freedom is involved here. The right of individuals who depend
on prayer rather than drugs to maintain health is infringed by blanket medica-
tion. This basic religious freedom is precious and cannot be conveniently
ignored every time a new cure-all is suggested. Certainly it is within the scope
of technical possibility as well as conscience to provide medication for those
who want it without forcing it upon everyone. Certainly su,ch a course is more
in accord with democratic ideas and constitutional practices.
Let it be known that Christian Scientists are vitally concerned with
health and with the public interest. No bona fide Christian Scientist
endangers a community by his actions or his religious beliefs. Chris-
tian Scientists are good citizens; they observe law and order; they
report communicable diseases promptly and strictly observe quaran-
tine regulations. They contribute much to the health and well-being
of their communities.
Our particular desire in this instance is to point out that a funda-
mental freedom is endangered here under the guise of benevolent
public welfare.
We urge that individual freedom be preserved and recommend the
passage of H. E.. 2341.
The Chairman. Thank you very much. Any questions?
Mr. Heselton. Mr. Watt, do you have the citation to the case you
refer to ?
Mr. Watt. Yes ; it is in the statement.
Mr. Heselton. Do you have the volume and page number?
Mr. Watt. No ; I do not.
Mr. Heselton. Is that a district court ?
FLUORIDATION OF WATER 61
Mr. Watt. It is a trial court at Shreveport, La.
Mr. Heselton. A State court ?
Mr. Watt. I do not know which court.
Mr. Heselton. In your presentation you phiced emphasis upon the
first article of the Constitution and referred to the Bill of Rights. I
wondered if, in connection with any fluoridation program that has
been undertaken, has there been a challenge as to it being unconsti-
tutional because of that first article ?
Mr. Watt. When the question first came up here in Washington, I
came to the Appropriations Committee, both the House and the Sen-
ate, and pointed that out, and you will find a short statement from
me on the record. I think it was about the only one that did come at
that time. I happened to have talked with Senator Hill about it at
various times. At various places it has come up and Christian Scien-
tists have joined with others in presenting this point of view. We
make only one point on it.
Mr. Heselton. What I had in mind was this : Has any effort been
made to establish the constitutionality in the court?
Mr. Watt. I do not know.
Mr. Heselton. You do not Imow what the facts are as to who
Mr. Mark E. Chapman is or the ground of the alleged violation ?
Mr. Watt. I do not know, and the reason I used his statement was
to have the opinion of a judge, and it was a trial, and evidence was
submitted, and to have the opinion of the — that it was a form of medi-
cation, because that was one of the controversial points. Some people
say that it is not medication and some say it is.
Mr. Heselton. I understand that.
Mr. Watt. That was my only reason for using the quotation.
Mr. Heselton. I understand that it has been some 20 years, during
which the program has been instituted in various States, communities,
and counties, and I was wondering if the Christian Scientists had at-
tempted to establish the unconstitutionality in the courts on the ground
that it was a violation of the first article of the Bill of Rights.
Mr. Watt. The Christian Science Church as such, certainly has not.
If there has been anything like that, it would have been by an indi-
vidual, who might have been a Christian Scientists, but I do not know.
Mr. Heselton. That is all.
Mr. Watt. Someone has handed me the opinion here.
The Chairman. Do you desire to make it a part of your remarks ?
Mr. Watt. I could give it to Mr. Heselton.
Mr. Heselton. I should like to see it.
The Chairman. Do you care to interrogate the witness further,
Mr. Heselton ?
Mr. Heselton. I think not, Mr. Chairman.
Mr. Priest. Will the gentleman yield?
Mr. Heselton. Yes.
Mr. Priest. Do you know whether this relates to the question be-
fore us ?
Mr. Heselton. I will be very glad to indicate that.
It is the opinion of the presiding judge of the First District Court
of Caddo Parish, La., and it is an action by Mark E. Chapman and
others against the city of Shreveport and they sought a preliminary
writ of injunction to prevent the fluoridation of the publically owned
62 FLUORIDATION OF WATER
and o})erated city waterworks, and I take it from what Mr. Watt has
said that the injunction was issued. And judgment was entered ac-
cordingly.
(The opinion above referred to has been placed in the committee
files.)
The Chairman. Are there any further questions? If not, we
thank you, Mr. Watt, for your appearance and your statement.
Mr. Watt. Thank you, Mr. Chairman.
The Chairman. I notice from the list of witnesses that has been
handed to me that some have come a great distance: 1 from Toledo,
1 from Springfield, Mass., and 1 from San Francisco, 1 from Worces-
ter, another from Hartford and 1 from Seattle, Wash., and some from
Boston.
I would like to give recognition to those who have come great dis-
tances first.
The next one on my list is Dr. Frederick B. Exner, fellow of the
American College of Radiology.
Mr. Pelly. Mr. Chairman, Dr. Exner is a constituent of mine and
comes very highly recommended by a great many well known people
in my Congressional District. I noticed this morning that one of the
witnesses referred to the University of Washington and I believe Dr.
Exner has had some connection with the University of Washington,
and as my colleagues will recognize, it is always a pleasure when we
have a witness from our own district.
I thought perhaps you might permit me at this time just to say a
few words in welcoming Dr. Exner as a witness before he begins his
statement.
Dr. Exner. Thank you, Mr. Pelly and Mr. Chairman.
The Chairman. I realize, Mr. Pelly, that you would have a great
deal of pleasure in having Dr. Exner here as a witness today, espe-
cially in view of the fact that he has a background that entitles yon
to be proud of his achievements. We certainly are happy to have
you here. Dr. Exner, from the district that is so ably re]n-esented by
Mr. Pelly, and you will carry back to Seattle, if you will, that we have
no more faithful or able member of this committee than Mr. Pelly
who comes from the city of Seattle.
Dr. Exner. Mr. Chairman, I shall be very happy to do so and I
wish to state that I am personally very proud of Mr. Felly's work.
The Chairman. You may proceed. Dr. Exner.
STATEMENT OF DR. FREDERICK B. EXNER, FELLOW OF THE
AMERICAN COLLEGE OF RADIOLOGY, UNIVERSITY OF WASH-
INGTON
Dr. Exner. I have attempted to Ijrief my testimony to save the
committee's time. I hoi)e I have not mangled it in the ])rocess but
you will find all of it in the statement.
The Chairman. I notice, in your statement, you say that you have
briefed it.
Dr. Exner. Yes.
The Chairman. Do you mean that it has taken 40 pages to brief it ?
Dr. Exner. No, sir. I mean, I am about to brief it now; I am
about to brief the 40 pages, I hope.
FLUORIDATION OF WATER 63
The Chairman, Yon may ])roceecl.
Dr. ExNER. I am Frederick B. Exner, doctor of medicine, fellow
of tlie American College of Radiology. 1 am something of a "jack-
of-all-trades." My father was professor of chemistry at Carleton
College, Northfield, Minn., for many years, and I practically grew np
in the chemistry laboratory. I was graduated from Carleton College,
bachelor of arts, 1921, with two majors, mathematics and chemistry.
I took postgraduate work there in organic chemistry in the sunmier
of 1923. I taught chemistry and physics at Faribault, Minn., from
1921 to 1923.
I taught physics and chemistry for 2 years in high school and
while in medical school, I took an extra summer quarter, and took
elective work in pathology and physical chemistry; and also did some
s])ecia] work on statistical studies of growth with Richard Scammon,
one of the ])ioneers in "biometrics.''
From 1930 to 1933, 1 took j)ostgraduate work combined with teach-
ing in radiology and pathology, at the University of Minnesota.
Since that time I have engaged in the private practice of radiology,
including dental X-ray, mostly in Seattle.
While at Mimiesota. 1 did pioneer work on mass-X-ray case finding
of tuberculosis. My latest paper on the subject was published in
July 1952. I was twice president of the local Antituberculosis
League (Christmas seals), was for more than 10 years a consultant
to the State department of health, and have been on the medical ad-
visory connnittee of the State department of vocational rehabilita-
tion. I include these facts because it has been maliciously stated that
I am opposed to everything aimed toward the public good.
I am a physician in good standing.
I am a member of the house of delegates of Washington State
Medical Association and have been 4 times president of the State
Radiological Society, 6 times secretary of the Association of Amer-
ican Physicians and Surgeons, am counselor for Washington for the
American College of Radiology, and a member of its commission
on legislation and public policy: I am a member of the faculty of
our medical school, medical ethics and economics.
I speak here strictly as an individual, expressing my own opinions.
The medical school, particularly, wants it expressly understood that
it has no official opinions on the subject of fluoridation.
The following testimony is based on more than 2 years of intensive
study.
The Chairman. With the reputation you have. Dr. Exner, and
the background of your study and experience, I can very readily
understand why Mr. Pelly took great pride in presenting you here
today, and took occasion to refer to the fact that you were one of
the outstanding physicians.
Dr. Exner. Thank you.
There is nothing controversial about facts. Controversies arise
over matters of opinion. I hope, therefore, to keep my testimony as
factual as possible.
Facts are stubborn things. AVhen you defy them you get in trou-
ble. The dark ages were dark because instead of seeking facts, peo-
ple permitted themselves to be bound by official opinions, mostly
handed down from Aristotle. We can consider that science was
64 FLUORIDATION OF WATER
born when Galileo dropped two balls from the Tower of Pisa, and
established that facts take precedence over authority. We can fore-
see the death of science in Russia, where it must conform to the party
line, and where they already have an official theory of heredity.
Most of us are not aware of a similar danger here. Yet in this
matter of fluoridation we come dangerously close to "official science."
We don't ask: "Is this thing true?" "Does it make sense?" "Does
it conform to common knowledge?" Instead, we ask ""VVliat does
Dean say?" "What does Arnold say?" "What does McClure say?"
Or "What does the A. D. A. or the A. M. A., the A. W. W. A., the
National Research Council, or the Public Health Service say?" And
we fail to notice that when any of these organizations speaks on the
subject, it is merely Dean, Arnold, or McClure in a different hat.
Dean, Arnold and McClure have done much work on fluorides,
mottled enamel, and tooth-decay; but instead of examining their
methods, or looking at their data, we merely ask: "What do they
say?" Let's look at what they say.
F. J. McClure of the Public Health Service was asked by the coun-
cil on foods and nutrition of the A. M. A. to write the section of fluo-
rine for the second edition of its Handbook of Nutrition (Lewis, Lon-
don, 1951). His article was also published without references in the
A. M. A. March 12, 1949 (pp. 711-713). The later actions of the
A. M. A. were largely influenced by what it says, and even more by
what it fails to say.
On page 148 of the Handbook, and page 714, Journal of American
Medical Association, McClure makes this statement: "Fluorine in-
gestion from domestic waters, even in areas of greatest fluorine con-
centration, would rarely exceed 8 to 10 milograms daily."
Disregarding Bauxite, Ark., where Churchill of Aluminum Re-
search Laboratories reported 13.7 parts per million of fluoride in
water no longer used, we may assume that McClure meant water with
8 to 10 parts per million.
Even so, we find that McClure, Mitchell and others experimented
on conscientious objectors during the war (Journal of Industrial
Hygiene and Toxicology, June 1945, pp. 159-170). We find (p. 163)
when they were kept in a hot, humid room, with only casual activity,
and permitted to drink Galesburg water, with 1.9 parts per million
of fluoride, they got, on the average, 9.7 and up to 12.2 milligrams
fluoride per day. On the basis of 10 parts per million this corre-
sponds to 51 milligrams per day, a far cry from the 10 milligrams in
the handbook.
Even under comfortable conditions the same men averaged 5.4 milli-
grams per day, corresponding to 28 milligrams at 10 parts per million.
Given Urbana water, with 0.3 part per million of fluoride, the
averages (p. 164) were 1.8 milligrams and 0.6 milligram correspond-
ing to 60 milligrams and 20 milligrams respectively at 10 parts per
million. It seems that McClure was singularly unimpressed with his
own findings when he wrote the material on wliich we all rely for ac-
curate information.
Meanwhile the same Handbook states (p. 475) that —
the volume of sweat may reach 2.5 liters (each about a quart) an hour in men
at hard work at a high environmental temperature.
FLUORIDATION OF WATER 65
This would, if my figures are correct, amount to an extra 16 or more
liters per 8-hour day of needed fluid. Even at the recommended 1.0
parts per million this would amount to a total of about 6.5 milligrams
per day, and provide a significant additional hazard to men working
where they are exposed to fluoride.
Let's look again. In 1944, at Cleveland, McClure told the xVmerican
Association for the Advancement of Science that —
children up to age 12 years, also exposed to drinking water containing 1.0 parts
per million fluorine, will ingest via food and drinking water about 0.8 to 1.1
milligrams fluorine daily, equal to about 0.05 milligram fluorine per kilogram
body-weight.
If true, and even assuming that they all get 0.3 milligram or less in
their food, then every child up to 12 years old must drink 1% pints
of water per day and weigh 44 pounds. I don't believe it. Yet state-
ments based on these figures of McClure's are quoted all over the place
as "scientifically proved fact."
Let's look again. In the same handbook (p. 145) , McClure says :
In an attempt to assess the hazard of cumulative fluorosis from fluoride waters,
an extensive survey of tlie fluorine concentration of urine specimens of high
school boys and of young selectees * * * was made by McClure and Kinser.
The reference is to Public Health Report 59 : 1575, 1944.
This tells how pooled specimens from 15 to 20 or less persons each
were analyzed and found, within a wide range, to have about the same
concentration of fluoride as the local water. From this he concludes
(Handbook p. 146) that-
upward of 90 percent of water-borne fluorine in concentrations of 0.5 to 4.5
parts per million is eliminated in the daily urine of teen-age boys and young men.
The conclusion of course is a gross non sequitur and the whole
thing a tissue of fallacies. One of the more obvious is that he totally
disregards water loss tlirough the skin and from the lungs. You can
see the latter on a cold day.
In an article by Machle, Scott, and Largent which McClure likes to
quote (Journal of Industrial Hygiene and Toxicology, 24: 199, Sep-
tember 1942), there is an account of 9 months water-balance study
on one individual. It showed that the daily urine outj)ut was just half
the daily fluid consumption, and about a third of the daily water
from all sources. That excludes water from foods as well as other
sources. xYctually, then if jNIcClure proved anything he proved that
less than half the daily fluorine intake is put out in the urine. Never-
theless his false conclusion is accepted as "scientific fact" and used
as a basis' for further conclusions.
Now, with regard to Dr. Arnold, we will have more to say about
fluoride storage, but first let's look at what Dean and Arnold say,
Arnold confines himself largely to quoting the work of others. How-
ever, in the Journal of American Dental Association, January 1948,
page 30, he quotes an article of which he is coauthor. He says :
In Aurora, 111. * * * only about 0.4 percent of the anterior teeth showed even
so much as the mildest form of fluorosis.
There is some doubt as to what he meant by "anterior teeth." If he
means the 8 incisors, the 633 children had 5,064 anterior teeth. If he
meant the upper central incisors, which are the ones most commonly
afl'ected, they had 1.266. Four-tenths percent of the first figure is 20
66 FLUORIDATION OF WATER
teeth. Four-teiitlis percent of the secoiicl fiaiue is 5 teeth. The orig-
inal article (Public Health Report, Aprit 11, 1941, p. 790), how-
ever, tells us that 57 incisor teeth were affected. This may have been
an honest error, but it appeared in the most widely read, by far,
dental journal. It has never been corrected, and influenced the think-
ing of many dentists. Also, it is often quoted.
Now, with regard to Dr. Dean, what does Dean say? As a matter
of fact, he has said so much he has been given honors and medals.
He is quoted all over the world. He quotes himself extensively, in
1 case from 11 previous articles. But what he quotes is mostly his
opinions and conclusions. This gives them far more weight than if
he merely stated them. He rarely quotes his actual findings.
So that we may know what we are talking about, and with your
permission, Mr. Chairman, I would like to show you at this point
some pictures taken from Dr. Dean's writings. This was originated,
as far as I can tell, in a book primarily on dental health. The same
publication was put out by the American Association for the Advance-
ment of Science and was headed by a committee of which Dr. Dean
was a member.
This picture on the left is the one under consideration. I hope you
can see it. It gives a picture of normal teeth, of questionable mottling,
and of fluorosis, of very mild mottling, and severe.
Now, in some earlier works. Dr. Dean used artists' drawings instead
of photographs. In photographs it is so difficult to distinguish be-
tween the highlights and white flecks that Dean himself wrote on
some of the pictures that he has published.
These are photographs and it is very difficult to tell, but on the
artists' drawings, made under Dean's supervision, you can find that on
the questionable range, there are a lot of low white spots shown by
the artists on the front teeth. And if you read the description which
goes with the pictures, you will find that the teeth are described as
definitely abnormal.
With regard to very mild classification, looking here, you do not
see very much unless you are told what to look at and then you are not
quite sure what it means.
You will find in 1934, Dr. Dean published a classification of mottled
enamel, in which he stated that the characteristic brown stains, the
Colorado brown stains, the Texas stain, that caused this condition,
that there is a disfiguring quality, disfiguring even when it is only
white, but more so when it is brown.
But in 1934 Dr. Dean said that brown stain does not occur in the
very mild classification. The article written the following year, he
had learned better, because at that time he said that it rarely occurred
and if it does occur, it is — I do not remember the exact wording — but
it is very limited, almost such as to be impercentible.
In 1935 the wording was repeated and in 1938, so there is no pos-
sibility of our getting confused on having found an earlier article
published in 1935 of a later article published in 1934. However, that
is a matter that is covered in detail in the written testimony.
I merely Avanted to show you something of what you are looking
at on the mild type as it is very definitely shown on this illustration the
brown stains, that there is a lot of brown stain in the mottled division,
and that we do not have picked categories where you go through and
FLUORIDATION OF WATER 67
separate the squares from the triangles, but that this is a continuous
gradation, and somewhere between here and here is a borderline, be-
tween tlie mihl and the mottled, and that perhaps even if there is
reason for wanting to find more mild an<l more moderate, you might
find it — some of it has slipped over this way, or vice versa, because
those types of things happen in any scientific investigation and lead
to the general rule that where you have an interest in the investigation
you are conducting, that the results are sure to be modified by bias,
even with the most scientific intention.
Dean has said so nnich it is hard to know where to start. For
example, in Public Health Reports, April 11, 1941, page 762, he says:
It is obvious tliat whatever eltect the waters with rehitively liigh fluoride
content (over 2 parts per million of Fahrenheit) have on dental caries is largely
of academic interest ; the resultant permanent disfigurement of many of the
users far outweighs any advantage that might accrue from the standpoint of
partial control of dental caries.
But in Pelton and AVisan's Dentistry in Public Health (Saunders,
Philadelphia, 1049) page 145, Dean says:
The Question is frequently raised why certain children have no mottled enamel,
while others in the same family using the same water supply have it. * * * a
number of factors may be kept in mind : Normal f)iologic variability, natural
differences in sensitivity (or resistance), amount of water drunk, amount of
milk consumed, dietary and culinary habits, and doul)tless other unrecognizable
variables influencing fluoride intake.
It is common knowledge that children habitally consume widely
different amounts of fluids. It is also common knowledge that in one
case a child may be imrsed, and later drink nothing but milk and
juices, eat canned sou])S, and canned or steamed vegetables; while
another may be fed milk powder dissolved in water, and later drink
nothing but water, eat home-made soups and boiled vegetables. It is
clear that one may easily get 10 times as much fluoride as the other,
and that any statement that 1 part per million is safe and 2 parts
excessive; or that one-half ])art is safe and 1 part excessive, is just
plain silly. The 2 to 1 differences are insignificant alongside the
individual differences. Yet such is the basic postulate on which the
case for fluoridation stands or falls.
In Public Health Reports, December (>, 1935, Dean says :
For public health purposes we have arbitrarily denied the minimal threshold
of fluoride concentration in a domestic water supply as the highest concentra-
tion incapable of producing a definite degree of mottled enamel in as much as
10 percent of the group examined.
In a footnote, he explains :
A community is given a "negative" mottled enamel index when "less than 10
percent of the children show 'very mild' or more severe types of mottled
enamel."
On the basis of his work, the Public Health Service, in 1942, adopted
1 part per million a.s the maximum permissible amount of fluoride in
public water supplies. It w^as considered that more than that amount
caused so much damage that it must be removed, or a different source
of water found.
Yet in 1952 he testified under oath (Delaney hearings, pp. 1647-
1653) that from 1 part per million of fluoride in the water (a) there
would result no "objectionable" fluorosis from a public health stand-
68 FLUORIDATION OF WATER
point, or in other words, that less than 15 percent of children would
get "very mild" or more severe degrees of mottled enamel; (h) no
child would get personally objectionable fluorosis, and that anything
that attracts attention is objectionable; (c) that there would be no
brown stain or dull white opacity; {d) that any teeth classified as
"mild" (as distinguished from "very mild") would invariably be sec-
ond bicuspids or molars (back teeth which are not seen) ; and (e) that
in teeth showing "questionable" mottling the changes are "so very
slight you don't even know what it is."
These things simply are not true. I have personally seen teeth that
developed in Denver, using water with one part per million of fluoride,
that were stained. The front teeth were mottled with brown, and it
was obvious at first glance from across the room.
In Tristan da Cunha, where the water contains 0.2 part per mil-
lion of fluoride, R. Soggnaes (Journal of Dental Research, August
1941, pp. 303-322) founcl that 30 percent of persons between 6 and 19
had mottled teeth ; that 60 percent of the upper central incisors were
affected; that they showed "white spots in the enamel" described as
opaque areas of a whitish color ; that "the lesions were obvious enough
to be revealed at the first smile of many of the younger inhabitants";
that even deciduous teeth were affected; and that the diagnosis was
confirmed by chemical analysis of the teeth.
A study by the Public Health Service in 1951 (Public Health Serv-
ice Reports, 68, p. 504, No. 5, May 1953) , found 18 percent of children
affected where there was only 0.8 part per million fluoride. What is
more, 2 percent were classified as "moderate," and 1 percent as "severe."
(On the basis of this study, it has been recommended that the fluorida-
tion level in hot, dry regions be 0.6 instead of 1 part per million. It
is also suggested that the amount of fluorosis be usecl as a biological
test of how much water children consume. (What it would actually
indicate, if anj^thing, would be the water consumption of 6 to 8 years
previous.)
Also, in 1951, Maier of the Public Health Service (Proceedings of
the Fourth Annual Conference of State Dental Directors with the
Public Health Service and the Children's Bureau, p. 65), said that
"the criterion we have been using is that if there is some 10 to 20
percent fluorosis in the community, that would not be objectionable,
because in those places the degree of intensity is not greater than the
accepted designation of 'mild'."
Dean stated that his testimony was based on the study of the "21
cities." The listed authors are Dean, Arnold, Jay, and Elvove. The
actual examinations were done by Johnston and Short, except at Wau-
kegan and again at MaywoocT where their diagnostic criteria were
"calibrated for a few weeks" by Arnold. The work extended from
September 1939 through October 1940, and was reported in Public
Health Reports, April 11, 1941 (hereinafter referred to as study II).
In each study, the cities were given a mottled enamel index "in ac-
cordance with a previously described method," and the reference is
to chapter XII, by Dean, in Gordon's Dental Science and Dental Art
(Lea & Febiger, Philadelphia, 1938, and hereinafter referred to as
Dean, 1938).
To my knowledge. Dean has published five descriptions of mottled
enamel classifications, as follows:
FLUORIDATION OF WATER 69
1. Journal of the American Dental Association, August 1934, pages
1421-1426 (hereinafter referred to as Dean, 1934) .
2. Public Health Reports, March 29, 1935, pages 425-427 (referred
to as Dean, 1935).
3. The one in Gordon, cited above as Dean, 1938.
4. One in Florine and Dental Health (AAAS, Washington, 1942)
(referred to as Dean, 1942) .
5. One in the report of the bureau of public relations of the ADA
written by Dean and Arnold (Journal of the American Dental
Association, August 1943, pp. 1278-1283), and referred to as Dean,
1943.
He has also presented illustrations of the classification in :
6. Chapter VII, of Pelton and Wisan, Dentistry in Public Health
(Saunders, Philadelphia, 1939) (referred to as Dean, 1949) ; and
7. In the hearings of the Delaney committee, 1952.
Dean 1934, 1935, and 1938 are substantially identical with one im-
portant difTerence. In 1934, Dean said : "No brown stain is present"
in the "very mild" classification. By 1935, he had learned better, and
said:
Brown stain is rarely observed in the mottled enamel of this classification,
and, if present at all, is so faint as to be almost indistinct.
This wording is repeated .in Dean 1938.
In this connection we should note two things :
(a) All these studies were made on children, and Dean knew
that brown stain if present would darken with age, and if absent
might appear later. In the Journal of the American Medical Asso-
ciation, October 17, 1936, page 1269, he said :
Teeth affected with mottled enamel * * * erupt showing a dull chalky white
appearance which in many instances later take on a characteristic brown stain,
the frequency of the brown stain increasing with age.
This is confirmed by his own studies, by other studies by the PHS, and
by the work of Massler and Schour (Journal of American Dental
Association, February 1952, pp. 156-165) who found that the ap-
parent damage increased right up to age 60. As a result, teeth clas-
sified as normal at age 14 may later be "questionable," and many of
the "questionable" are proved to have been "very mild" or "mild."
(h) Dean also knew that the amount of brown stain, even of badly
mottled teeth, varies widely in different communities, and says:
Many cases of white opaque mottled enamel, without brown stain, ai*e classi-
fied as moderate and listed in that category."
(Dean 1934, 1935, and 1938.)
The illustrations in Dean 1934 and 1935 are identical and are artist's
drawings. They show extensive changes on the front teeth in the
"questionable category". The later pictures are photographs, and in
general it is impossible to distinguish white flecks from high-lights.
However, in 1934, he says they may show —
occasional white spots, 1 to 2 millimeters in diameter —
and in 1935 and 1938 he says :
In addition, the summit of the hiciTspids often shows an unusual white opacity
2 or 3 millimeters in extent.
70 FLUORIDATION OF WATER
In 1934, 1935, and 1938, h<j says these teeth are "definitely not normal"
but indicates that there may be doubt as to the cause. In 1934 he says :
No attempt is made to diagnose these small white spots or minute white
fleckings as the earliest signs of mottling by examination of the person per se.
Recourse is always made to group study.
This is what he meant in the Delaney hearings, top of page 1649, when
he said :
You don't know what it is.
And as to balancing the light 3 or 4 ways with a mirror, in Public
Health Keports, September 10, 1937, page 1252, he says :
At Clovis, tlie diagnosis of the degree of mottled enamel severity was based
on a careful visual examination without the aid of mouth mirrors. * * * The
signs of chronic endemic dental fluorosis are so objective that little variation in
incidence is noted using eitlier one or the other of these methods.
So much for the category of '"questionable". "Very mild" is the
next category and, as we have seen, sometimes shows brown stain. In
Dean 1934, 1935, and 1938, we are told that it is—
principally observed on the labial and buccal (i. e. toward the lip or cheek)
surfaces ; that it involves up to 25 percent of the affected teeth.
And in all three descriptions of "mild" fluorosis we are told :
The white opaque areas * * * involve at least half the tooth surface —
and
light brown stains are sometimes apparent, generally on the upper incisors.
In Dean 1942, he describes his new "weighted average" method for
calculating a "community index of fluorisis" and gives, on page 26, a
greatly abridged description of the categories. It omits all mention
of brown stain in the "very mild" and "mild" categories, although in
all the seven sets of illustrations brown stain is shown on the upper
front teeth of "mild" fluorosis. And, whereas Dean 1934, 1935, and
1938 had said that in mild fluorosis "at least half" of the tooth surface
was involved, in 1942 he says that —
the white opaque areas * * * do not involve as much as 50 i)ercent of the tooth.
Under "very mild" in the 1942 statement he says :
Frequently included in this category are teeth showing no more than about
1/2 millimeter of white opacity at the tip of the summit of the cusps of the bicus-
pids or second molars.
And at the Delaney hearings he stated that such was usually the case.
However, in the earlier classifications such teeth were called "ques-
tionable" unless the areas were also pitted, or larger than % millimeter.
In a footnote, he explains that —
In our earlier studies such teeth were commonly classified as "questionable" ;
during recent years, however, they have been invariably listed as "very mild."
He thus implies, without saying, that the 1942 classification was used
in studies II and V.
But as we have seen on page 11, supra, the original reference is to
Dean 1938. There is much supporting evidence, both statistical and
documentary, of the use of the 1935-38 classification. For example, in
Public Health Reports, February 10, 1939 (the same year studies II
FLUORIDATION OF WATER 71
and V began) a footnote referring to Dean 1935 (identical with
Dean 1938) reads:
ThLs classification of diagnosis lias since been abridf^e<l by combining "mod-
erately sevex'e" and "severe" into one classification : "severe" — HTD.
I can find no other mention of revision until 1942.
Furthermore, Dean testified (Delaney hearings, pp. 1647-1648) that
the reconnnended figure of 1.0 parts per million was based on "the
study of the 21 cities" and was the "result of plotting a curve on the
21 cities." (See fig. 1, appended.) And throughout his testimony
kept basing his ansAvers on evidence from "the 21 cities." This is the
study by Dean and others (Public Health Report, Apr, 11, 1941, and
Aug. 7, 1942) to which I have referred as studies II and V.
THE TRUTH ABOUT THE 2 1 CITIES
But elsewhere in his testimony (pp. 1652 and 1653) Dean stated
that data from Maywood and from Marion were without significance
because of changes in the water supply during the lifetime of the
children examined. That reduces the 2i to 19.
Repeatedly, and over many years. Dean has pointed out that no
conclusions can be drawn from the quantitative studies made where
there have been changes in the source or composition of the water dur-
ing the lifetime of the group examined. He said it in Dean 1938,
page 405. He said it in study 11. He said it in Public Health Re-
ports, December 6, 1935, on page 1720. And he said it in the Amer-
ican Journal of Public Health, June 1936, page 569.
In the last article cited, on page 573, he lists Galesburg as lacking
the "requisites for quantitative evaluation" because of changes in the
water up to 1928. Nevertheless, he used Galesburg as one of the key
cities in his case for fluoridation. The statement that protection
against decay exists eA^en in the absence of visible mottling is based
on Galesburg (and rests on a fallacious argiunent at that). The
promised two-thirds reductions in tooth decay is based on the Gales-
burg-Quincy study. And Galesburg was used as one of the "21 cities."
So now we have 18.
But that is not all. If we study the water histories of the 21 cities,
as given in studies II and V, we find that not only in Galesburg, May-
wood, and Marion, but also in Elmhurst, Aurora, Joliet, Elgin, and
by specific statement. East Moline, there were changes which make
them completely unreliable as evidence. Now we are down to 13,
and there is a real question about Lima.
So, actually the 21 cities of which Dean testified boil down to Colo-
rado Springs with 2.6 parts per million, Kewanee with 0.9, Pueblo
with 0.6, and 9 cities with 0.2 or less parts per million of fluoride.
These facts were published in Dean's original articles, and it is
reasonable to assume that he knew them then. They completely in-
validate all conclusions based on the study, which means the entire
case for fluoridation. He knew this in 1952, as his testimony proves,
and we may assume he knew it all these years. And if the articles
were ghost-written and he actually didn't know w^hat was in them at
the time, he should have told the world when he found out. Instead,
he testified under oath about 21 cities.
72
FLUORIDATION OF WATER
THE STRANGE CASE OF AURORA
Aurora is the second key city in the case for fluoridation. It is the
one used to prove that front teeth are not affected. It was also one
cf the cities selected by McClure for his strange studies on fluoride
retention and on fluoride effects on bones and growth. (He also used
Galesburg, Joliet, and Elgin, as well as Amarillo and Lubbock, Tex.,
both listed by Dean in 1936 as lacking the requisites for quantitative
evaluation.)
It is also the city used as a basis of comparison with Grand Rapids
in the Public Health Service experiment. Fluoride was added at
Grand Rapids (1945), Aurora was the standard of expected results,
and Muskegon was left without fluoride as control.
The water history of Aurora is therefore important. The children
studied (studies II and V) were 12 to 14 in the fall of 1939. Thev
were born in 1925, 1926, and 1927.
Up to 1940, Aurora used water from 13 wells (according to study
II). The amounts contributed by the different wells was quite
variable.
Well No.
Year drilled
AmouBt of fluoride
Date abandoned
1
1891
1892
1893
1895
1910
1915
1916
1916
1923
1923
1928
1929
1936
Not given.
2
Do.
3
Do.
4
Do.
5 _ .
Do.<
6
0.5 parts per million
Still in u.se.
7
0.7 parts per million
Do.
8 - _ - .
1.3 parts per million ..
Do.
9
do
1.1 parts per million
Do.
10 -
Do.
11 . . . _ .
(2) _
Do.
12
(2)
Do.
12a-.
(2)
Do.
1 Well No. 5 was out of use and no water pumped from it during 1935-39 (and for an tinstated prior period).
It was repaired and returned to use in 1940. The fluoride content after repair is not given.
2 A mixture of these waters in unknovm proportion in 1939 showed 1.2 parts per million. Between 1935
and 1939, these 3 new wells supplied from 40 to 70 percent of the water.
It is clear that the water used by these children while their front
teeth were forming (up to about age 3 or 4) was not the same as that
used while the bicuspids and molars were being formed later. It is
also clear, from the lack of fluorosis in the front teeth that the earlier
amount was significantly lower. (This is the only known cause for
this finding and has been frequently observed.) In spite of all this,
15 percent of the children had definitely mottled teeth, and 32 percent
more had questionable mottling.
Nevertheless, on the same page on which the water history is given,
Dean says :
From the standpoint of a population exposed for a long period of time to a
water supply containing small amounts of fluorides, Aurora appears to offer
many advantages for epidemiological study. Since 1898 the public water supply
has been obtained from wells into the Cambrian Potsdam sandstone. (Italics
mine. )
He fails to mention that they passed through and received varying
amounts of water from the water-bearing Niagaran limestone, and the
St. Peter sandstone. From then on he settled for telling people that
Aurora has used the same type of water supply for over 50 years.
FLUORIDATION OF WATER 73
I believe it can be shown that, without exception, the witnesses for
fluoridation testified falsely, but in the other cases it is harder to show
that they did it knowingly. In general they were merely parroting in
irresponsible fashion, things they had been told. My notes indicate
that some of them have perjured themselves elsewhere, but I have
not yet had an opportunity to examine the actual record of their
testimony.
FAULTY METHODS USED
One of the things they teach you in grade-school arithmetic is that
you can't add dissimilar things. This is not because of any narrow-
minded rules, but simply because the number you get doesn't mean
anything. The 5 you get by adding 1 boy and 4 bicycles has nothing
to do with the 5 you get by adding 4 boys and 1 bicycle, and neither
is 5 of anything.
You can't even add different sized units of the same thing. One
foot and four inches isn't five of anything. It is either 16 inches, or
11/3 feet.
These things don't work in arithmetic or anywhere else in mathe-
matics. Neither do they work in physics, in chemistry, in engineering,
or anywhere else. Any time you do them, you are in trouble.
Yet, when the men who should know better add up decayed, filled,
and missing teeth, getting something they call a DMF rate ; and when
they tell us things based on comparison of such rates; we bow in
reverence and do whatever they tell us to do even if it kills us.
UNRELIABLE EXAMINATIONS
But that is not all. You can't even tell how many teeth are de-
cayed. In the Journal of the American Dental Association, December
1941, pages 1959-1961, Radusch (chairman of the Minneapolis caries
study group), reports a comparison of work done by 8 dentists exam-
ining 33 patients. Each patient was examined by 3 (in 1 case only
2) examiners who could take as much time as they liked and knew their
findings would be checked by the others. The reported findings show
a standard deviation of from 40 percent above to 40 percent below
the average number of cavities found.
The same sort of thing occurs when the same man repeats his own
examinations. Dirks, Amerongen, and Winkler (Journal of Dental
Research, June 1951, pp. 346-359) , found that by cleaning and drying
the teeth, using rubber dam, separators, and spotlights, spending 4
to 5 hours on each examination, with 2 examiners each making 2 exam-
inations and comparing results, they would get fairly reproducible
findings. They discarded the method as too cumbersome and still
too inaccurate to be reliable.
X-RAY ALSO UNRELIABLE
When you use X-ray, you are no better off. It is more reliable for
cavities between the teeth, but less reliable for cavities on the exposed
surfaces. In the Journal of the American Dental Association, Aug-
ust 1934, Ennis tells us, on page 1373, that on examining 883 students
he found 1,662 decayed teeth clinically as against 1,372 found by
X-ray but that the examinations agreed in only 237 cases. Decay
74 FLUORIDATION OF WATER
was found clinically but not by X-ray in 1,4:25 teeth, while it was
found by X-ray but not clinically in 1,135.
And to cap it all, Durkett (Journal of Dental Research, vol. 20, pp.
70-76, 1941), found that 54 percent of cavities found microscopically
were found by neither X-ray nor clinical examination.
p:xperiments meaningless
These things are not too serious from a personal standpoint. If a
cavity is of any consequence, it will get big enough to find. From
an experimental standpoint, however, they are devastating. Neither
individual nor statistical comparisons can have any meaning. You
can compare two mouths and be very sure that one is better than an-
other, but you can't attach any number with any possible meaning to
the dift'erences.
For these reasons, the experiments at Newburgh, Grand Eapids,
and elsewhere can never prove anything if they go on a hundred years
(except probably that they have produced mottled teeth, and pos-
sibly that they have caused more or less serious other damage, and
when these things become known, it will be far too late to undo the
damage).
And there are other reasons why most of these experiments will
never prove anything. They w ere not designed to ascertain facts, but
to prove a point. Blayney, at Evanton, has used faulty methods,
but has made a serious and sincere attem})t to run a respectable scien-
tific experiment. He, however, is frowned upon in public health circles
for being honest.
All this boils down to the plain fact that there is no possible basib
for the promise of 65 percent reduction in tooth decay. Neither the
experimental nor the "epidemiological" evidence proves anything.
And you couldn't even know if it occurred. It is our fantasy, and
fraudulent fantasy at that.
It is true that there are places w'here there is more fluoride and
less tooth decay than in others. There are also places where the re-
verse is true. We aren't told about the latter. Figure 2, appended,
shows examples.
Figure 3 shows the lack of any reliable relationship between the
amount of fluoride in the water and the damage done to teeth. The
figures are accepted at face value from the literature. If anyone wants
to prove that they are unreliable, it's all right with me. Almost all
of them are quoted from Dean. Ockerse found (Dental Caries, De-
partment of Health, Pretoria, South Africa, 1949, p. 51) that —
it was not possible to correlate the degree of mottling with the amount of
fluroine in the drinking water.
He attributed this to variations in the amounts present in the same
supply. As we have seen, there are other important reasons.
OTHER FLUORIDE DAMAGE
We have seen that jMcClure claims to have proved that fluoride
cannot accumulate in the body because it is almost all put out in the
urine. We know his proofs are false. But in any case, "the proof of
the pudding is in the eating.''
FLUORIDATION OF WATER 75
In the Journal of the Anieiican Medical Association, October 17,
1936, page 1273, Dean says that —
bones of the residents of Colorado Springs or C^'ripple Creek contain about six
times as mucli fluorine as "control" bones which were from New York City
and Washington, D. C.
In the same article, page 1270, he says :
Lemmou, a pediatrician of Amarillo, Tex., an endemic area, records that
"some of these babies have more tendency to bowing to the legs, even in the face
of constant antirachitic therapy, thus supporting the theory that the toxic
fluorides interfere with bone and dental metabolism."
In 1933 (Physiological Reviews, vol. XIII, No. 3, July 1933, pp.
277-300) McClure reported (pp. 295-296) that—
Stuber and Lang observed a number of hemophilic patients (bleeders) with
amounts of blood fluoride so abnormally high, that they were led to suspect
fluoride as a causal factor.
And that—
the blood of normal persons residing in Freiburg, Germany, would clot in 9
luinutes, whereas in the region of Kiel, the clotting time varies from 10 to 17
minutes.
And that —
Analysis of Kiel tapwater revealed a relatively high content of fluorine as
compared with Freiburg water, which contained no fluorine.
In the same article, page 291, he reports that —
dilutions (if sodium fluoride as low as 1:1.5,000,000 (one-fifteenth part per mil-
lion) may inhlltit the action of lipase (a fat-splitting enzyme).
Almost everything that happens in the body is accomplished or in-
fluenced by enzyme action, yet in the American Medical Association's
Handbook of Nutrition, McClure casually mentions (p. 143) that —
fluorine is a powerful antienzymatic agent —
and says (,p. 148) that —
The effects of fluoride on enzymatic processes were recently reviewed thoroughly
by Borei —
in a foreign publication for which McClure gave an incomplete
reference, but which I have.
XO PROOF OF SAFETY OF FLUORIDES
When a drug is added to tlie public water supply, the burden of
proof that it is safe should rest on those who put it there. It should
not be necessary to prove it harmful.
However, I can find no record that at New^burgh or elsewhere, any
proof has been offered that fluoride does not cause bowing of the
legs, or increased tendency to bleeding, or osteomalacia in the aged,
or osteosclerosis or otosclerosis, or premature aging, or interference
with tlie development of the jaw with malposition of the teeth, or
increased pyorrhea, or any of the other effects that have been reported,
much less those we may not yet suspect.
I cannot find reports of blood-calcium levels, and they should be
made on individuals, and not be determinations on "pooled blood"
like McClure's pooled urine analysis.
48391—54 6
76 FLUORIDATION OF WATER
PROOFS FROM CENSUS FIGURES AND VITAL STATISTICS
The "proofs" offered by tlie Public Health Service based on epi-
demiological studies of vital statistics and census figures are so
meaningless that it is funny. There is no proof of fluorine content
of the water in past years, and no proof of how many individuals
used it how long. It is known that ill effects may take 30 years or
more to become manifest. Yet few cities have had an unchanged
water supply for 30 years, and not too many people stay put for 30
years.
Moreover, most of the effects of fluoride are unreported in the
vital statistics. We don't report bowed legs, or deafness, or hemo-
philia, or osteomalacia, or even stiff back (and it can become literally
stiff as a poker) . And if they were reported, there is nothing in the
report to show which were caused by fluoride and which were not.
That might be determined by chemical analysis (as in Keil and
Freiburg) but it rarely is. There is little incentive since no one can
undrink water consumed last year, much less 30 years ago.
You will be told that these things do not happen at one part per
million, but they can and do. We have seen that it is the dose, not
the parts per million, of fluoride that matters. Tenfold differences
in intake from the same source are commonplace.
In a Public Health Service investigation (Public Health Keports,
Oct. 26, 1951) on page 1398, Eussell and Elvove report that, both at
Boulder, with no fluoride, and Colorado Springs, with 2.6 parts per
million —
The percentages of third molars in eruption which were decayed, missing, or
filled was high, rising with age from 70 to nearly 100 percent at Boulder, and
from 50 to over 90 percent at Colorado Springs.
About three-quarters of all DINIF third molars were missing in both groups.
At Boulder 94 percent of third molar loss was reported as due to dental caries
and about 3 percent due to malposition of the teeth. At Colorado Springs about
36 percent of third molar loss was reportedly due to dental caries and about
62 percent due to malposition of the teeth.
This figures out that 23 times as many third molar teeth were lost
because of malposition, at Colorado Springs as at Boulder. This
sounds like quite a significant difference and I, for one, would rather
lose a wisdom tooth because it was decayed than have it dug out
because it came in crooked.
OTHER FALSE STATEMENTS
You will be told that all fluoride ions are alike, regardless of their
source, which is true. You will be told that because of that, the
effect of sodium fluoride added to the water can be expected to be
the same as that of fluoride naturally occurring in the water, which
is absolutely false. The chemical behavior of fluoride ions is vastly
different depending on the company they are in. This is even more
true of their physiological behavior. . , , • -a
In general, fluoride-bearing waters have picked up significant
amounts of other minerals, and especially calcium, along with the
fluoride. Adding sodium fluoride, a form in which it rarely if ever
reaches natural waters, to a water of relatively low mineral content
cannot be expected to produce the same, or even similar results.
FLUORIDATION OF WATER 77
Deatlierage reported (Dental Fluorosis, AAAS, Washington, 1942,
p. 83), that in a certain region was a form of shale which —
contained glauconite, natural greensaud, which softens the water percolating
through it and also furnishes fluorides. It is these soft waters which cause the
most severe mottled enamel.
You will be told that the addition of fluoride is no different than
the generally accepted addition of chlorine. This is wholly false.
It is true that fluorine and chlorine belong to the same family of
chemicals, despite which they are chemically as different as day and
night, and physiologically as different as day and bicycles.
The amounts of chlorine used are not known to be harmful and the
amounts of fluoride are. Chlorine can be readily removed from the
water by heating and fluoride cannot. Also, there is an essential
difference in the purpose for which they are added.
Chlorine is added to make the water safer, by destroying more
harmful things which are, or may be, present. Fluoride is added
for the purpose of acting on, and altering, the body of the consumer.
Chlorine is intended to destroy typhoid bacilli. Fluoride is intended
to act on you and your children.
THE WATER SUPPLY IS NO SUITABLE VEHICLE FOR MEDICATION
Quite aside from the moral, legal, philosophical, and religious ob-
jections, which should preclude any thought of fluoridation, there are
medical reasons against putting any drug in the water supply. In
fact, it is medical insanity.
You don't mix a solution of any potent drug, hand it to a patient,
and say : "Take as much as you like. You are sure to get the desired
effect and can't be harmed."
When any drug is added to the water supply, its dose is tied to
water consumption, which is highly variable and wholly unrelated to
need for the drug. Moreover, if my child drinks little water, and I
think he is not getting enough of the drug, I dare not give supple-
mental dosage because I can't know how much he is already getting
in the water.
It follows that only the exceptional child who happens to drink the
expected amount of water can get a correct dose. All others will get
too much or too little.
Another important objection is that it is impractical to use "drug
grade" chemical in the water. It is too scarce, and too expensive.
The fluoride they use is meant for industrial use, not human con-
sumption. No druggist would be permitted to dispense such impure
medicine even if his conscience would let him.
OTHER METHODS AVAILABLE
If and when fluoride is proved desirable, it can be individually pre-
scribed and dispensed. It can be now, although few physicians or
dentists do so, either for their patients or their families. This in
itself should cast doubt on the project to force it on everyone.
Alternatively, it can be added to milk, or to salt, and in either case
the dose can be controlled far better than in the water supply. (Salt
consumption is far less variable than water consumption, and fluoride-
free salt would, of course, also be available.)
78 FLUORIDATION OF WATER
Any of these methods would be safer, could be cheaper, and would
be crenerally preferable to putting it in the water. Moreover, they
would be optional, and based on education rather than compulsion.
And that is precisely why the Public Health Service opposes them so
violently.
Beyond any reasonable question, the sole purpose in wanting to
add fluoride to the water supply, rather than offer it in some saner
fashion, is so it can serve as precedent for compulsory medication in
noncontagious disease.
THE PHS IS DETERMINED TO "PUT OVER" FLUORIDATION
The Public Health Service has already spent amounts running into
the millions on the direct and indirect promotion of fluoridation, and
when Surgeon General Scheele told State and Territorial Health
Officers (Public Health Report, February 1953, p. 177) that^
The skeptics must be convinced that our epidemiological and laboratory
studies are valid and that the benefits of fluoridation are not to be discarded
lightly in the face of uninformed opposition —
nobody thought he was kidding; or that he meant they should pro-
duce some valid studies. It was a directive to get out and sell a bill
of goods, and it came from the man who controls the subsidies on
which they depend.
Nor is that the only place where hope of reward and fear of punish-
ment enter in. And when the University of Washington, or of Mich-
igan, puts on what amounts to indoctrination courses in pseudoscience,
or when the people from Texas want it made very clear that the uni-
versity is not to be held responsible for Alfred Taylor's objectionable
findings, the hope of subsidies or fear of their loss may enter in.
TOTALITARIAN MEDICINE
We hear a lot about socialized medicine, and it has been charged
that fluoridation will lead to that. Such is not the case, and if it
were, so what. We already have socialized medicine all over the place,
and good or bad, nobody seems to get much excited about it.
Socialized services are offered at the taxpayer's expense, and you
are free to use them or not as you choose. Fluoridation is totalitarian
medicine, in that it is compulsory, and things are done to your body
whether you like it or not. Its only purpose (except for the secondary
one of providing jobs and "empire") is to serve as precedent for com-
pulsory medication.
And in Public Health Reports. January 1952, page 5, the Public
Health Service stated editorially its —
conviction that physical fitness, for civilians as well as for troops, was a duty
owed the Nation.
JUST ONE OF MANY
Fluoridation is no isolated aberration in the public-health move-
ment. You will find the same things going on in the fields of tubercu-
losis, of cancer, of polio, of mental disease, and even of nutrition.
And if they don't scare us, they should.
The newest thing in public -health circles, these days, is something
called "behavior-centered health education." Its essence was well ex-
FLUORIDATION OF WATER 79
l)ressed to me 1 clay here in Washington, D. C, in 1950, by an old
friend of mine. He said:
We are under no obligation to tell i>eople the truth. They couldn't understand
it anyway. Our duty is to tell people whatever will make them do what they
ought to do.
The same point of view was expressed by Frank A. Bull, director
of dental health in Wisconsin, where 50 of the first 100 cities put in
fluoridation. It was at a symposium on fluoridation of public water
supplies at the University of Washinoton, on April 27, 1951, and he
said:
The public has a right to expect leadership from us. If we are going to
present this fluoridation program to the public with a lot of indecision * * *
we might as well forget all about a fluoridation program. * * * People must
be told definitely what they should or should not do to bring about an improved
public health. When through our collective research, thinking and judgment,
we have decided that fluoridation or any other procedure is a public health
measure then we must tell the public that they should adopt that program and
explain to them how and why we arrived at those conclusions without creating
unnecessary doubt and suspicion in their minds.
THE rOUKTH ANNUAL CONFERENCE
From June (> to 8, 1051, the Public Health Service and Children's
Bureau held the Fourth Annual Conference of State Health Directors,
in the Federal Security Building. The proceedings of the conference
should be required reading, but are difficult or impossible to obtain.
All I have are photocopies.
This same Frank Bull was brought to tell the health directors how
to '"put over""" fluoridation. They were told how to rig endorsements,
how to use civic organizations, and especially PTA's, how to use the
press, how to "build a fire under people," how to "give the business"
to engineers and waterworks i)eople, how to play off one group against
another, and so forth.
They were told to have some sort of answer for every argmnent, not
to permit opposition on the program, and never, if it could possibly be
avoided, to let the matter come to the vote of the people.
They were told what to say, and what not to say, what words to
avoid. For example, they were told to admit that fluorosis would
result, but to say that fluorosis in that amount made teeth more
beautiful.
At the end they listened to reports of "group discussions"' which
recommended that "fluoridation should be the spark to kindle a desire
for a full scale dental and general health plan in the community,"' and
that they should use the term ^''e<xg shell white rather than chalky
white in describing tooth color." (It is now referred to as "pearly
white.")
They were also told that if there was something the health depart-
ment wanted to do that didn't come under the definition of "public
health" they should just "embroider the definition a little bit" and
then it w^ould be all right.
And at all this, gentlemen, there was no word of protest ! And what
they did when they got home is in the record. They did as they had
been told.
80 FLUORIDATION OF WATER
SUMMARY
In 1944, McChire told the American Association for the Advance-
ment of Science that children up to age 12 years drink 1% pints of
water a day and weigh 44 pomids. Of course he didn't say it in
those words, but that is the way what he says figures out. And what
he said is an important part of the foundation for all you are told by
the fluoridizers.
He said nothing about averages, but if he had it would still be
just as silly. Averages don't drink water, nor do they get mottled
teeth or softened bones. It is people, each an individual and every
one different, who do these things.
McClure wrote the section on fluorides for the second edition of the
American Medical Association Handbook of Nutrition. In it he states
that even where water fluorides are highest, people will rarely get
more than 8 to 10 milligrams of fluoride daily. But if you allow for
the different concentrations, you will find that the average intake of
inactive subjects in one of his own experiments was the equivalent of
from 2 to 6 times this amount, depending on the climate. If they had
been active, the amounts would have been much higher.
In the same Handbook he tells of some experiments he performed,
from which he concludes that —
upward of 90 percent of waterborne fluoride (in concentrations of 0.5 to 4.5 parts
per million) is eliminated in the daily urine of teen-age boys and young men.
What his experiment actually showed was that less than half the
fluoride in that range was eliminated.
Evidence on these matters is given in detail in my written testi-
mony. We have only time here for a sketch summary. But it is
important to remember that these statements of McClure's, and those
by Arnold and Dean which I shall cite, form the basis of the case for
fluoridation. They are accepted at face value, enlarged, embroidered,
and paraphrased, and are repeated so often they are accepted as truer
than truth.
Now, as to Arnold. In January 1948 Arnold misstated the findings
in his own work. His statement is a little ambiguous, but by the most
generous interpretation he understated the number of disfigured front
teeth of Aurora children by 65 percent. This was in the most widely
read dental magazine of all.
The mainstay of the fluoridators, however, is H. Trendley Dean,
formerly with the United States Health Service. He has long repre-
sented the American Dental Association in matters pertaining to
fluorine. With Anold he wrote an official American Dental Asso-
ciation report on mottled enamel in 1943.
He was adviser to the committee of the American Water Works
Association that recommended "endorsement" of fluoridation. He
was a member of the ad hoc committee of the National Research
Council that endorsed fluoridation.
He was a member of the committees that put out books on fluorides
for the American Association for the Advancement of Science in
1942 and again in 1946. He wrote chapters on fluorides in Gordon's
Dental Science and Dental Art (1938) and in Pelton and Wisan's
Dentistry in Public Health (1949), as well as dozens of articles.
FLUORIDATION OF WATER 81
In everything he writes, and in everything based on his writings,
it is stated or implied that the effects of fluoride are dependable deter-
mined by the concentration in the water — that certain things occur
at 1 part per million, and quite different things occur at 0.6 part, or
2 parts or 5 parts per million.
For example, he assures us that no harm will be done at a concen-
tration of 1.0 to 1.5 parts per million, but that whatever effect waters
with over 2.0 parts per million have on dental caries is largely of
academic interest because the resultant permanent disfigurement of
many of the users far outweighs any advantage from the standpoint
of reducing tooth decay.
Now, it is true that the dose of fluoride depends to a degree on the
concentration, in much the same way as the interest you pay depends
on the rate. But in the one case you must know how much money
you borrowed and in the other how much w^ater you consume.
You are told that the differences in water consumption are trivial,
which we all laiow just isn't true. You are further told that McClure
has proved that everybody on the average consumes about a quart
of water a day and will get about 1 milligram of fluoride per day
from water with 1 part per million of fluoride. Believe it or not, this
is told you in all seriousness by learned dentists and scientists; and
if you question it, or the conclusions they draw therefrom, you are
uninformed, a crackpot, and lack proper respect for the voice of
authority.
But, as we have seen, McClure's own work proves it untrue, as if
we didn't know it already. And, as I have pointed out in my written
testimony, differences of 10 to 1 in individual water consumption are
very ordinary. Disregarding all other factors, these offset the differ-
ence between 1 part per million and 10 parts per million, and Dean's
distinction between complete safety at 1.0 to 1.5 parts per million and
disaster at 2.0 parts per million is, as we said before, just plain silly.
Actually, the complete safety that Dean talks about has nothing
to do with what happens to individuals. He has repeatedly said
that his epidemiological studies relate to groups, and not to indi-
viduals, and that prognosis with respect to any individual is obviously
impossible. His original meaning of the word "safe" was that it
would not cause obvious disfigurement of more than 10 percent of
children. He has since learned that more than that will be dam-
aged by his recommended one part per million, and has revised his
definition of safety to allow for damage to 15 to 20 percent.
Moreover, Dean's work was concerned Avith children up to age 14,
and Dean knows that, although the primary damage occurs while
the teeth are being formed, before they erupt, it becomes increasingly
evident with age: and tliat if he examined the same group a few
j^ears later he would find worse damage and to more individuals.
Furthermore, and whether Dean knew it or not, it is generally
recognized that the damage done by fluoride, both to the teeth and
to the system generally, depends greatly on the diet, and especially
on how much calcium the body gets.
I have also cited evidence that 9 of the famous 21 cities on which
the case for fluoridation rests fail to meet Dean's own requirements
for reliability. Water histories proving this were included in the
original reports, but have not been mentioned since.
82 FLUORIDATION OF WATER
Either the water supply was chaiiired during the critical period
while the teeth were bein^ formed, or chan<Ted later in such a way
that we cannot know the fluoride concentration when the teeth were
formed. The 9 include all but 1 of the cities in the important ranfje
of concentrations. Consequently all conclusions are void, and the
whole case for fluoridation falls apart.
Furthermore, I have shown that Dean knew that Galesburg did
not meet his requirement when he used it to prove that fluoride
would produce a 65-percent reduction in decay; and when he used
it to prove that protection from decay exists even in the absence of
visible fluorosis; and later, when he selected it as 1 of his 21 cities.
The city of Aurora is of critical importance, so its water history
has been consistently misrepresented. It is the city used for com-
parison in the artificial fluoridation experiments. But its real im-
portance lies in the fact that it is the city always quoted to prove
that mottled enamel attacks only the back teeth when the concentration
is low.
Of course, this is not true, and is proved untrue by all observa-
tions everywhei'e. There are places where it ap])ears to be true, both
at hijffh and at low concentration. The reason is known, and lias to
do with the period at which different teeth develop.
Children born where there is no fluoride, but who chanire in early
childhood to a water with fluoride, end up with teeth like those in
Aurora. The water history makes it clear that this is exactly what
happened, but Dean has covered up by saying that Aurora has had
the same type of water supply for more than 50 years.
So far we have seen that the so-called experimental basis for
fluoridation is faulty. My testimony next showed that all the talk
about 65 percent, oi" any other specified reduction in tooth decay, is
nonsense for two reasons : First, because there can be no unit for
quantitative estimate of decay (the so-called D. M. F. rate makes no
more sense than when children count up pennies, dimes, and quarters
to see which has the most money) ; and, second, because the margin
of error in recognition of decay is so great that 65-percent differences
are not significant.
Because of these unavoidable factors, and also because of gross
faults in the methods, the so-called experiments at Newburgh, Grand
Eaj^ids, and elsewhere can never prove anything about tooth decay.
They can, on the other hand, be expected to damage the teeth, and
probably the bodies, of countless children, although it is still far too
early for the worst damage to be manifest, and, contrary to the prom-
ises of Dean and others, we can confidently expect the worst damage
on the upper front teeth.
So much for the dental effects of fluorides. The nondental effects
are far more to be feared. In spite of McClure's so-called experiments,
it is a fact that fluoride does accumulate in the body and that it does
do important damage. It is a further fact that damage can occur at
1 part per million of fluoride. A Public Health Service study, where
the fluoride was only 2.6 parts per million, showed some 23 times as
many third molar teeth lost because of malposition than in a nearby
fluoride-free city.
It is also known that fluoride damage is greatly increased whenever,
for any reason, the ability of the kidneys to put out fluoride is impaired.
FLUORIDATION OF WATER 83
I can find no evidence of any serious attempt by the Public Health
Service to find evidence of fluoride damage. The work they have done
seems directed solely toward {)rovin<2: that none occurs and the proofs
are not impressive. There has been some very sketchy work on the
bone-hardening effects (osteosclerosis) of fluorides.
I find no mention of the bone-softening effects (osteomalacia), al-
though they are probably far more common. A report from South
America estimates that there are some 10,000 cases in the Argentine.
It is the connnonest form in animals, both experimentally and natu-
rally, and was described by Bartolucci in 1012, some 20 years before
either the dental effects or the bone-hardening effects were known.
Neither have the other known effects of cumulative poisoning been
sought. I can't even find record of any wide-scale blood-calcium or
calcium-retention determinations.
The so-called epidemiological evidence ])ut out by the Public Health
Service is wholly without value. First, there is no water history of
the cities, and few cities have had an unchanged water supply for ?>()
years, which is the time needed for certain effects to appear; second,
there is no attempt to eliminate persons who have lived elsewhere or
used other water ; third, most of the effects of fluorides are not reported
in vital statistics; and, fourth, the known effects of chronic fluoride
poisoning can all be duplicated by other causes.
The plain fact is that no respectable evidence for the safety of
fluoride has ever been offered, wdiile there is abundant evidence of
danger; and when something is to be added to a public-water supply,
the burden of proof should certainly rest on those who claim it safe
rather than on those who say it isn't.
There are abundant and compelling reasons why, even if everything
we are told about the safety and effectiveness of fluorides were true,
it should still not be put in the water supply. As I have pointed out
in my written testimon}', it is medically insane. But, far more impor-
tant, it violates our inalienable right to final decision as to what shall
be done to our own bodies except when exercise of that right creates
a clear and present danger to the right of others. In this connection
it is clear that the so-called experiments at Newburgh and (irand
Rapids are in flagrant violation of the most sacred laws of God and
man.
It is also in violation of our God-given right to make our own
mistakes instead of having self-stylecl experts empowered to make
worse ones for us without our consent.
We are now confronted with a gigantic steamroller, fabricated by
the Public Health Service, powered with unlimited Federal funds,
and directed from Washington. It is designed to put over the greatest
hoax in history, and to destroy, once and for all, the constitutional
protections of the citizens. It gives control over our bodies to a grou])
of men who believe that "physical fitness is a duty owed the Nation,"
that they are under no obligation to tell the truth but should rather
tell people whatever will lead them to do as they "ought" ; to men who
think fuzzily in term of "average people," and are willing to sacrifice
up to 20 percent of individuals to improve something they call "the
public health" and can't define.
In my written testimony I have given some indication of how the
steamroller works, and the results are manifest everywhere we look.
84 FLUORIDATION OF WATER
I believe that H. R. 2341 is needed to stop all this, and respectfully
request the committee to bring it out with a recommendation of "do
pass."
I believe, however, that this is just a start on what needs to be done.
I have extensive evidence of similar activities in many other areas of
so-called public health, and I am convinced that we need a thorough-
going investigation of all sucli activities. I ask this committee to do
all in its power to bring about such investigation.
And, finally, I wish to request that my entire written testimony,
with its documented refutation of tlie Public Health Ssrvice pseudo-
science, be included in the record to serve as source material, and to
help counteract the mountains of misinformation that have been pub-
lished on this subject at Government expense.
The Chairman. Will you suspend for just a moment. Dr. Exner.
I want to see where we are with reference to time, and the people who
are present and those who will testify.
(After informal discussion with various people listed as witnesses,
as to length of time that they would require, the following proceedings
were had:)
The Chairman. You Iniow, it is awfully difficult for me to say to
anybody who has come a distance such as some of these witnesses indi-
cate, which indicates their very great interest in the subject and a very
great interest on their part, to limit them as to the time that they
should use in speaking; and that applies to these others, too.
I wish the committee were in a position to give you all of the time
that you want, but we have so many duties to perform, you know, that
it is not possible for us to stay here as long as you might wish or as we
might wish.
(After further informal discussion:)
The Chairman. The committee is going to go into executive session
for about 5 minutes. So, I will declare a recess so that the committee
may have an executive session and I hope that 5^ou folks who are here
in favor of the resolution will agree among yourselves as to what time
you should have and be able to announce that to me when we re-
assemble the committee in about 5 minutes.
(Thereupon, the committee took a recess as above indicated, after
which the following proceedings were had:)
The Chairman. The committee will be in order. Someone has
placed on my desk a statement that four witnesses, proponents of the
bill, have not been called as yet. If I have not called any of their
names, will you rise and give j^our names ?
(After further informal discussion as to time required by witnesses,
the following proceedings were had:)
The Chairman. Have you folks agreed upon any division of time
between yourselves? If not, the committee will divide the time ac-
cordingly. We will allow each witness 15 minutes. With 11 witnesses,
that is 165 minutes. That would be 45 minutes this afternoon, until
half past 4, and 2 hours tomorrow morning.
Now, if in that division of time, there is anyone who wishes to
give or yield his or her time, or any portion of it, to some other wit-
ness, they may do so. That is a custom that is very frequently carried
out in the House by which one Member will yield his time, or part of
it, to other Members who wish to speak.
FLUORIDATION OF WATER 85
Mr. Francis J, Garvey (American Denatal Association) . Mr. Chair-
man, on behalf of the opponents of the bill, I would like to inquire
if the committee plans an afternoon session tomorrow, so that I may
ask some of our members to catch a plane this evening.
The Chairman. We are hopeful.
Mr. Garvey. Thank you, sir.
The Chairman. Of course, we are in the hands of anyone who may
wish to i)rechide us from doing so. Then we will have to make the
time up to you in some other way; but you may rest assured you will
have the same amount of time that the proponents have.
Mr. Garvey. Sir, I was thinking of the convenience of the com-
mittee. Some planned to be here Thursday morning instead of to-
morrow afternoon, thinking they would be on at that time, and I was
trying to get them here tomorrow afternoon.
The Chairman. That is nice of you to think of our convenience.
I want you to realize we are here for the purpose of giving you folks
a hearing and we propose to do so. I do not want you to misunderstand
the purpose.
Now, let me ask you. Dr. Exner, how much more time you expect
to take.
Dr. Exner. Mr. Chairman, I can assure you that I have no inten-
tion of taking anything like 2 hours. I was practically through.
What you referred to as interpolated material was taken out of the
back portion of my oral presentation, and I was in fact almost through.
The Chairman. I will say that jou have made a very clear presen-
tation.
I do not know, but I imagine that a great deal of what will be said
will be repetitious. In other words, I doubt if every witness could
present a different, entirely new story, from that which has already
been given. But we must proceed and get through.
Now, how much more time do you wish ?
Dr. Exner. I hope to be through in less than 2 minutes, sir.
The Chairman. Thank you.
Dr. Exner. What I wish to say is that I have presented the bulk
of what I feel is necessary to present as oral testimony, and with your
permission, I would like to merely have appear in the record my
written testimon}^ as it has been presented witli what I have said con-
sidered a mere summary of the testimony and with that statement, I
am very glad at this point to withdraw in favor of some of these people
who have come so far.
The Chairman. Well, Dr. Exner, I want you to know, and other
witnesses, that their entire statement will appear in the record. I
must say, however, that in connection with yours, you have some charts
connected with it. I am not sure whether, under the rules of the
House, we can make those charts part of the record, but your testi-
mony will appear in the record in full, and in the event the charts
are not made a part of the record, if you wish to write a description
of each, instead of the charts, we will see if we cannot get it in the
record in lieu of the charts.
Dr. Exner. I would be very glad to do that, and I will not take
more of your time. I thank you.
(The description of the charts follows: )
86 FLUORIDATION OF WATER
Brief Verbal Description of Figures I, II, and III, Surmitteb in Evidence by
F. B. Exner, M. D.
Figure I: This consists of two graphs. The first represents Dean's 21 (se-
lected) cities, and shows the relationship between fluoride concentration in
the water and "dental caries experience." It has been reproduced many times
all over the world as proof of an alleged relationship between concentration
and freedom from tooth decay; and as proof that the protection can be ob-
tained at one part per million of fluoride in the water.
The second graph shows how the first graph would look if we eliminated the
nine cities that fail to meet the Public Health Service's own requirements for
reliability. The nine are eliminated because of changes in the water supply
during the lives of the children examined. The second graph makes clear that
there is no factual basis for the conclusions which have been di-awn from the
first.
Figure II: This is a graph that shows that Dean's 21 (selected) cities are in
no sense representative. The 9 cities with fluoride concentration of 0.2 parts
I)er million or less have an average of only 2 percent of children with no de-
cayed teeth, whereas the averaw of 17 other places with the same amounts of
fluoride finds 14 percent of children without tooth decay. (Tristan da Cunha
was not included or the difference would be much greater. There the fluoride
concentration is 0.2 parts per million, and there is no tooth decay in children
up to age 14).
Figure III : This graph shows the lack of any reliable relationship between
concentration of fluoride and the number of children with fluoride damage to
the teeth. It also shows that in this respect, again, Dean's 21 (selected) cities
are far from typical.
The Chairman. It is very embarrassing to me to say to you and
to the others, that it is necessary for us to do this, but we have made
up a schedule that runs into next month, and it keeps us right with
our noses to the grindstone to carry through on our schedule. We
appreciate the importance of the views you folks have. For that
reason they will be made a part of the record and the record will be
given a study in its entirety before the committee makes a decision
on this matter.
Dr. Exner. I wish to thank you for your courtesy, and to tell you
that I have no feeling at all of havinji been cut off, because I felt
when you brought up the question of time that I had actually com-
pleted", to all intents and purposes, what I planned to say. I thank
you.
The Chairman. Thank you.
(After further informal discussion as to time of witnesses, the
following proceedings were had :)
The Chairman. I would like to make this very plain that if there
is anyone present who has not testified, either because they would
prefer to put their statement in the record or because they wish to
give their time to someone else, they will not be penalized thereby.
Their entire statement will be made a part of the record the same as
if it had been delivered. The reason I am giving such broad discre-
tion as that is that I am assuming that judgment will be used in the
length of the statements. I do not want to have to refuse the entry
of books on the subject, and so forth.
STATEMENT OF DR. CHARLES T. BETTS, TOLEDO, OHIO
The Chairman. Dr. Betts, of Toledo, Ohio.
Dr. Betts is a fellow of the American Association of Educational
Research and president of the Anti-Cancer Club of America.
Dr. Betts. Mr. Chairman. Shall I proceed.
FLUORIDATION OF WATER 87
The Chairman. Please do so.
Dr. Betts. I noted you asked today ''Whom do you represent'"!'
I wish to state that I represent my five boys who have served this
country. They fouglit for freedom, and I am here following in
their footsteps — at least one of them, who passed away this week.
The Chairman. We will be very glad to hear you in their behalf.
Dr. Betts. Dr. MacWhinnie, of Seattle, Wash., says :
Step by step, a piece at a time, our Government planners witli their vast
resources of money, manpower, and time, are weaving a pattern to destroy all
vestiges of self-sutficiency in the average American and deliver him as a slave
to his Government ; all of which is done under the guise of social progress.
We have all been aware of this for years, and have deplored the
plaimed destruction of the very qualities that have made America
great. With the exception of voting at the polls, there was nothing
the average dentist could do about it until the advent of fluoridation.
This doctor was a member in good standing of the Association of
Seattle and was refused to have this article published in the dental
magazine.
I wish to state that basic science is composed of three divisions :
State board of examiners of dentistry, of medicine, and chemistry.
I am a dentist and have been for about 57 years. I fill teeth ; I drill
the decayed })ortions out and often use medicine to treat the tooth
before filling, for one purpose, to prevent decay and for the disease of
the oral cavity of human beings. That constitutes a part of the j^rac-
tice of dentistry.
We as dentists must learn the part which we play in public life as
in the practice of dentistry. We find that these men who treat people
through public water systems are practicing dentistry, medicine and
pharmacy. We find that they have no record of receiving a license to
do this work.
It has reached a j)oint where we have to look to law. We believe in
law. We have city charters. There is a city charter of Toledo [exhib-
iting paper].
I find nothing in there which allows any public official to practice
dentistry, law, or chemistry, by using the water department. That, as
Judge Gallow\ay said in Shreveport, does not apply to the public or to
the Congress of these United States to say otherwise.
Xow, I go over this country from council to council and of the many
councils to whom I have spoken, only two have turned me down. That
is Oberlin, and the one over there at Saginaw, Mich.
So, we find what the water people sa}-. The water people are those
who handle the water systems, and I quote from the Journal of Mis-
souri Water and Sewage Conference :
The waterworks i)rofession's greatest responsibility is acting only on scientific,
adequate, and convincing data. To advocate the fluoridation of all water supplies
is premature and unscientific. Fluoridation remains an experiment. The sim-
plicity of using the water supply as a vehicle for fluoridation and administration
of (tther propfjsed corrective and diet-deficient treatment is a temptation, but the
policy invites serious trouble that should be i-esisted by waterworks personnel.
Deficiencies fluorine as well as calcium, phosphorus, vitamins, etc., if prescribed
anywhere should be in the diet and not in the public water supply.
The first thing a dentist learns, or should learn, when he goes to
college is to learn how to prevent decay. That is his job.
88 FLUORIDATION OF WATER
Not once have I found in any curriculum of any college in this world
where he is taught that fluorine prevents decay. It does just the oppo-
site. I refer you to Funk &Wagnalls Dictionary. I will not read this
statement, because it was read here this afternoon ; but it shows how we
set metals, steel on fire, how it sets water on fire ; how it burns up and
burns through asbestos. So, I will not mention that.
I might say that we have the great number, or a number of fine
dental magazines in this country and almost in every one this subject
is well covered ; but who knows it ? The people do not know it. Here
is one that just came from the Dental Digest. This is by Dillon. He
says here that the mottling of teeth and the generative changes was
found to be the result of the use of thirty -nine hundreds of one part per
minimum.
Now, when it comes to the question of fluoridation — this comes
directly from Mrs. Sykes, who is head of the Women's League of
England :
Compulsory mass medication is immoral what ever the avfrnment for any
particular medicine may be. It is against the internationally accepted prin-
ciples which govern medical experiments on human beings. It cannot be justi-
fied by quoting enforced addition to our food in the past. The freedom to
choose or refuse — the right to contract out — is fundamental. If, in the future,
Montrose decides by plebiscite to fluoridate their water supply, then alternative
water supplies must be made available for all those who do not wish to drink
medicated water.
This letter is fi'om A. L. Miller, your Congressman here.
Many have asked about fluoridation of water in the District of Columbia. I
did introduce a bill in 19.51 to make this possible. After hearing the experts
on the subject, I withdrew the bill and apologized to my colleagues for intro-
ducing the measure. I was misled by the Public Health Service, just as many
are now being misled. The District officials, without authority from Congress,
proceeded to order fluoridation of water. They should have bad legislative
authority.
I was ill, 41 years ago, and the best physicians of our city said I
would have to pass on. I went to Colorado and there in 1913 found
this matter of fluorine, and I think the record will show that to be
the first of this country. Then, I began investigating what others
have said ; what others have found, and I have found every university
in the world ; I have found none of them which state that fluorine
saves teeth or prevents decay. Everyone of them ; just the opposite.
A very prominent man in our city, a reporter of the Toledo Blade,
came to my office, and I told him about that statement. He said how
about Dr. Black of Gainsville, Fla. I said, "I know Dr. Black." I
live in Florida half my time. When I find winter coming here, and
I find Dr. Black and his son are in the business of furnishing these
fluorides. Therefore, his testimony does not mean anything. I kept
a copy of the report of the University of Arizona. This report was
made in 1933, and it has 18 pictures in here showing what fluorine does
to the teeth and how it destroys the teeth. It destroys all of the
teeth of animals under their jurisdiction. They have worked on this
with guinea pigs, rats, and that is their work.
New Mexico said if the things are true in Arizona, they are just as
true in New Mexico. They put in 5 years ; 5 years studying this thing
out and sure enough they put out one here. [Indicating.] It shows
the menace of fluorine to health, and they give the references here.
They took them, found out, and published every one of the cities, show-
FLUORIDATION OF WATER 89
ing the fluorine content, and how it reduced disease ; not through pre-
venting disease.
Now we come to a real good one. This is from Cornell, New York
State Veterinary College, Ithica, N. Y. It shows here what it does
to the cows ; how they eat a little food for about o or 4 months, and they
lose their teeth. They not only lose their teeth, they get large
knuckles; they get very large knuckles. Their bones get soft and
when they try to reproduce, they fall down and break their necks, and
break their ribs. They become sterile. I mean, the cows become
sterile. They become sterile to such an extent that out of every herd
out of here, in our country, 20 out of a hundred are sold because they
have become sterile and of no account; and when you hit a farmer's
business, he does not like it. The result is that is the whole thinking
recorded in this book by Udall, at Cornell University — and this is only
2 yeai'S ago — 1952.
So, I have collected, and collected, all during these years these items,
and here you find where in England, it is called a cattle killer; the
cattle killer. It may affect vegetables, too. Here is the paper, and it
tells about how terrible it is to lose these cows by the hundreds in
England, and down here "the unseen enemy is fluorine.''
So. I ask our C. D. man here in Washington — civil defense — "What
can you tell me about this gas, this fluorine gas we feed to cows?"
He says, "We have no record. We have no record ; I am sorry to say
that I have no information about the episode of England to which you
refer, where livestock were killed and eaten — from eating food con-
taminated by fluorine."
Now, he says he cannot give me the formula.
I have been publishing the formula here for 2 years, nerve tests.
And, he has given 2 pages to this magazine — 2 of them. He went
before the Health Department and for a long time he had to keep it
under cover — for 3 weeks — and it was then given.
The Chairman. Dr. Betts, the clerk informs me that your 15 min-
utes have expired.
Dr. Betts. Fine. I am willing to close.
The Chairman. Will you leave with the committee those books to
whicli you have just referred, and any of these other papers that will
be exhibits in the case, for the study of the committee ?
Dr. Betts. I wanted to show you these items here. I have made it
up in this book form and folder, so j'ou can have a thousand times more
than I have given here today; a thousand times more, and there it
all is. I want to present this to the committee.
The Chairman. It will be given the study of our commitee and its
staff.
Dr Betts. We cannot understand why people do not react, when
they read things like this.
I appreciate the opportunity of having had this hearing. The first
time I have ever liad such a privilege.
The Chairman. We thank you for the information you have brought
to the committee, and I assure you that we will give it very careful
consideration.
Dr. Betts. Thank you very much. These [exhibiting papers] are
along the same line which I would like to have you consider.
The Chairman. The clerk will take possession of those statements.
(The statement presented by Dr. Betts is as follows:)
90 ' FLUORIDATION OF WATER
Statement of Dr. C. T. Betts, Toledo, Ohio
People and things change. Principles and facts — never. "The penalty sood
men pay for indifference to public affairs is to be rules by evil men." — Plato.
Basic science act is composed of three divisions — code for the practice of medi-
cine, code for the practice of dentistry, code for practice of pharmacy. All three
have a State lioard of examiners which examines applicants who uiust have
def^rees from their respective colleges and show fitness to practice their profession.
I am a dentist. I fill teeth, drill the decayed portion out and often a.se medi-
cine to treat the tooth before filling for one purpose — to prevent decay or further
disease of the oral cavity of human beings. That constitutes a part of the prac-
tice of dentistry. Prescribing medicine or chemicals to prevent disease of the
teeth or tissues of the oral cavity is dentistry now performed by water boards
through flnoridation or by placing metallics on the outside of the teeth to pre-
vent decay — just as I do by placing metal fillings on the inside of a tooth to
prevent decay. There is no difference. Both are the practice of dentistry.
Physicians also must comply with the rules, pass a State medical lioard exam-
ination before the.v can treat human beings for any disease or i)rescribe medicines
for internal or external use. This is the practice of medicine. Medics and
dentists are the only persons allowed by law to prescribe chemicals for treatment
of disease of the human family. A pharmacist is one who has a license from the
State pharmacy board to sell or compound chemicals to fill prescripticnis pre-
scribed by the medics or dentists for human disease.
The Federal Government is a higher authority so a pharmacist selling
potent poisons or drugs coming nnder the oi»ium or other act. must make a
complete report of such pnrchase and the buyer nnist siun his name on the
register at the time of purchase. The package nuist he marked with the sknll
and crossbones.
The code of law regulating the practice of the aliove professions is on file
at the examining board's ofiices in every State. It is definitely stated in all of
them what constitutes the practice of each and the fines provided for the
vidlati'.ms of them by those found guilty of "practicing without a license."
It is my ptirpose to show that many city officials, including water boards, are
now practicing all of the alxive professicms contrary to city charters. State codes
of basic science and the higher laws of onr Nation regulating human liehavior.
Such action was never taken before by public officials. Those of Germany. Adolf
Hitler and his underofficials applied the same principles as those now known
as the proponents of flnoridation. Water boards are now commanded by higher
(.fficials, mayors, councils, etc. to place medicine, drugs, or fluorides in public
water supply for the purpose of medical treatment of children (human beings)
to produce a physiological change in their bodies to prevent caries — the decay
of the teeth — that constitutes the practice of dentistry without a license — a
criminal act.
It should be noted that the amount of fluorine normally present in water
varies from one locality to another, and even within a given locality may vary
seasonall.v or even from day to day. as deternnned l^y weather conditions and
other natural forces. For this reason an actual control of the flu(»rine content
of the water being dispensed for drinking puri)oses would require constant
checking of the fluorine content of the incoming water, and a considerable
flexibility in the quantity of fluoride added to the water which is 8.1 percent
poisonous compared to 15 percent in natural fluoride. Such a l)lending of deadly
poisonous chemicals for dispensing to the public comes definitely within the
scope of our laws on pharmacy. The water departments thus are engaging in
an unlicensed practice of pharmacy. The prescril>ing of mixtures of water
and fiuorides to be sold for internal or even external use, where a medicinal or
prophylactic purpose is intended, comes within the practice of medicine — yet
the persons making the decisions, prescribing the amounts, and taking the re-
sponsibilities, are not doctors or chemists but ordinary citizens who serve in
elective positions on our city councils, without (in most cases) either license to
practice medicine or even the most elementary technical knowledge of the
physiological effects of chemicals on the various organs of the human body.
The law provides that the skull and crossbones be placed on such compounded
drugs before sale. The violation by water boards is very clear on this point.
Changing a public water system which belongs to the people, over into a medical
distribution system for profit to the purveyors of poisonous drugs and mixing
machinery, is something unbelievable in America, yet it is now operating on 17
million of our citizens (a promurder program) represented only as a child
FLUORIDATION OF WATER 91
tooth-decay preventative idea. May I call your attention to a recent case of a
lady in Ohio vpho firmly believed a drop of such poison would benefit her husband.
Such a small amount was perfectly safe * * *. She put it in his coffee.
Imagine, they charged her with murder and she was eventually electrocuted
ai the Ohio penitentiary. This lady was no more guilty than Hitler's gang
who were stopped at the end of a short rope, or our zealous fluoridators placing
a highly poisonous drug in the public water system.
Look at another fine Ohio city. I spoke to their council, showed them what
they would be doing if they attempted to kill their women and children with
these fluorides. In went the fluorides anyway. In 2 months, thousands were
covered with leprosylike sores. Now, $18,000 worth of fluorides are for sale,
also the machinery. Try and iiet the facts from the mayor, any member of the
city council or water board or even the newspaper. Evidently, somebody thinks
we have some short ropes in this country. Ever since time, as we know it, every
city has had laws to provide good, potable, clean, wholesome, pure water for
distribution to the citizens. Now, for the first time, officials are turning these
cities into chemical distribution water polution centers.
Our Civil Defense Governor, Val Peterson, spent 3 weeks behind closed doors
with our health department on this fluorine question and got nowhere with
them. He felt compelled to issue a warning. In doing so, he gave a press
release as follows :
[Toledo Blade, August 8, 1953]
'•Russia Expected To Use Neeve Gas in Any Attack on United States —
C. D. Chief Says — Public Reportedly Knows Little About Horror Weapon
"Washington, August 8 (NANA). — While the world's greatest fear in recent
years has centered around the atomic and hydrogen bombs, public concern for
other weapons — just as lethal in character — has all but gone by the board. One
of these is nerve gas ; by far the most potent war chemical known to man. Use
of this deadly chemical on unsuspecting, unprepared Americans — they know
little or nothing about it — it is no less a possibility today than an attack on the
United States by Russia. At a closed-door hearing last month (the testimony
was released 3 weeks later) Civil Defense Administrator Val Peterson told the
House Appropriations Committee that Russia would probably resort to nerve
gas and other chemical agents in any attack on this country.
"RUSSIA HAS THE KNOW-HOW
"Mr. Peterson's reasoning was based on two considerations : Nerve gas is
cheap compared to atomic bombs, and American officials are certain Russia has
the production know-how. Nerve gas is a German invention. Swarming onto
German soil in the closing days of World War II, the Russian Army made a
beeline for Hitler's war-gas plants. All the secrets were there including facts
about nerve gas, which all Americans should know. Nerve gas ranks with the
most horrible of weapons because of the alarming speed with which it downs its
victims. The extraordinary difficulties encountered in rescue operations and its
capacity for causing panic, it is difficult to discover until it's too late.
"gas is contagious
"Death can follow contamination in 1 to 20 minutes depending on the dosage.
And the gas is contagious. Contact with a nerve-gas victim can contaminate
physicians, ambulances, and hospital equipment. The sight of a victim in the
throes of a nerve-gas attack is terrible in the extreme. He struggles in vain
effort to breathe, experiencing wheezing, gasping convulsions and massive saliva-
tions. Nerve gas enters the body through the eyes, nose, mouth, and pores, seek-
ing out the nervous system. It does not affect the lungs or skin but by damaging
the nerves, it renders muscles useless and seriously affects the brain.
"Widespread ignorance of nerve-gas characteristics and the probable successs
with which it might be used against uninformed Americans is not the fault of
the public. They simply have not been informed. Many high-ranking ofiicials
are just as nuich in the dark. And still there are no signs which point to an
administration program designed to educate the public along these lines."
Our Federal Health, Education, and Welfare Committee instead of taking the
warning and stopping fluoridation at once, stepped up the pace and pushed to its
48391—54 7
92 FLUORIDATIOX OF WATER
/ith power. When Governor I'eterson saw this, he knew the only avenue to put
his warning over to the puhlic was to prepare an ai-ticle for a lay majiazine as a
highly colored attractive item. Collier's Weekly was decided upon and live
pages were given in the Xovemher 27, 1953, issue.
"G-Gas — A New Weapon of Chilling Tekkor
'•Quite apart from the danger posed by the fumes, it's possible that droplets of
the licpiid gas from a low bomb burst might spray civilians. Liipud CV, on the
skin is painless; it causes no irritation and doesn't burn or scar. A victim
wouldn't know it was there unless he saw it fall. But, if he didn't wash it off
at once with soap and water or a solution of washing soda, it would be absorbed
through the skin into the l)lood stream and cause his death within an hour.
How is it alisorbed? Doctors don't know. But they have found that ordinary
clothing, rubber boots, even gloves and laboratory clothing offer little protec-
tion— the liquid gas seeps right through them. Only specially treated decontam-
ination clothing provides protection and it must be continually washed down.
"Just how does the gas kill? It wrecks the nervous system. Our nerve
centers function because of two vital chemicals which the body produces. One,
acetylcholine, acts as a bridge between the nerve endings and the muscles and is
produced when the brain sends an impulse down to the nerve endings. The
second, cholinesterase. moderates the activities of acetylcholine. Without it,
acetylcholine accumulates until it causes excessive and nncontrollable muscle
activity and eventually convulsions. Nerve gas knocks out the cholinesterase and
the accumulating acetylcholine soons sends the muscles into convulsive spasms.
Paralysis and death follow."
Again the public paid little or no attention and looked upon it as merely a
news story rather than a warning Again fluoridation is stepped u]i and for the
first time in history, a Jlidwest city on April 11. lO.")!, passed fluoridation 100
percent and turned it over to the water l)oard. Fluorine has Iteen outlav.-ed by
the V. N. for any war purpose. Fluorine cf)mpound 1080 is used by the predatory
animal board to exterminate and in one season 9.1 percent of those animals in
Oregon and Washington were killed. Fluorine is a rat poison used by Val
Peterson for Government experiments to show how to protect Americans in case
of attack.
Our own H-bomb recently exploded 2.000 miles from our shores, showered
fluorine all over our country eating millions of holes in our automobile glass. It
etches or eats holes in glass 1 inch in diameter or larger when it conies in contact
with a speck so small it cannot be seen with the naked eye. I challenge anyone
to show a single law in our land which allows our water systems to be turned
into so-called medicinal dispensing agencies.
I challenge anyone to show that any professor or university of the world
where fluorine has been examined, has issued bulletins showing fluorine prevents
tooth decay — caries — or that fluoridation is not a hoax, or that fluorine does not
destroy teeth, or that fluorine does not destroy all the body, not only of children
but animals as small as chinchillas and as large as wolves and horses; or that
the Agriculture Department does not advise that it be given to brood sows because
it produces abortion. We are in the presence of men who advise that women
and children take this drug from the public drinking water system.
The council of Pasadena, Calif., voted to abandon the practice of medicine and
the dental profession by fluoridation ; that such criminal acts were outside the
duties of the council. This was confirmed by Judge U. Galloway of Shreveport,
La.. Injunction Against Fluoridation Granted, January 4, 19.'54, as follows:
"* * * medication, in law understanding, including prophylaxis or preventive
measures, when applied to the individual * * * Considering the end results that
are sought, we cannot escajie the conclusion that it is a form of medication, or
at least a scientific treatment of a sort of hydrotherapy ; by way of ingesting these
mineralized waters, of and for the children of the conuuunit.v. under 12 years of
age. No person or segment of the poimlation having that condition ( dental caries
or tooth decay) can on that account have any adverse effect on the health, dental
or otherwise, of the general public or of any segment thereof. We repeat, in our
opinion, this is not a matter of the public dental health. It is strictly within the
realm of individual and personal dental health and hygiene within which each
person should be free to choose his course for himself and those for whom he is
responsible in the family relation. To this field, the just powers of the Govern-
ment do not extend."
FLUORIDATION OF WATER 93
Foi- many years the Amerieau Dental Association spent larjue sums of money
to determine how to prevent caries; decay of the teeth: the prevention and care
of the disease. They sent Weston A. I'rice, D. D. S.. all over the \V(n-ld. For
9 years this man traveled into many countries; photographed and sought every
source of record information. On his return he was immediately placed on
(he ADA council. His findings were published in the Journal, afterward in the
book Nutrition and Physical Degeneration. 431 pages, the final paragraph of
which are these words : "Life in all its fullness is this Mother Nature Obeyed."
We read also in the book that "food is fabricated soil." Our life is maintained
by food, not by poisonous chemicals. For 30 years the great truths given by Dr.
Price has been heralded over the world.
Fluoridation, a new idea, was brought to the attention of the ADA as a
cure-all and the prevention of caries, b.v aluminum interests. Eleven fluorides
and aluminas are byproducts of the manufacture of aluminum. Mr. Oscar
Ewiug, an attorney for the aluminum interests, is claimed to liave been on a
stipend of $750,000 a year salary. He was placed at the head of our National
Security Administration at $17.r)00 .-uuiually. As soon as he got into this Fed-
eral position, a sudden emergency was declared to save children's teeth. The only
way to prevent caries was to place this deadly fluorine in our public water
systems, thereby increasing the sale of chemicals manufactured by his former
employers.
An army of agents called directors of national. State, county, regional and
divisional and other fancy names, for all the country. These persons are sent
to speak before PTA's, commerce, and many other clubs, councils and mass meet-
ings to tell how to preserve the kiddies' teeth. These men have plenty of
money ; they travel to and from all parts of the United States, wherever people
are known to object to drinking tiuoride poison; also money grants by the hun-
dreds are paid to university men in localities where citizens are known to be
questioning the merits of the use of fluoride in drinking water. Personally, I was
severely poisoned by this combined aluminum and flourine gas, so kept every
scientific publication I could find, during the last 41 years. When I learned that
men like Dr. E. V. Norton, Dr. Parran, and Dr. John Studebaker resigned be-
cause they refused to go along with the poison program, I too decided to remove
my coat and combat this trend to the best of my ability. I have addressed many
city councils and only Saginaw, JNIich., and Oberlin, Ohio, refused to listen.
The first record against polluting drinking water came from the Missouri
Water and Sewerage Conference. Jul.\- 10.jl :
"The ease with which a communal water supply can be made a vehicle for
the administration of all sorts of chemicals to the consumers, holds out great
promise but it invites trouble. Public health workers and waterworks engineers
and administrators have a grave responsibility which extends far beyond any
good or evil that may come from fluoridation of the water .supply, namely, the
responsibility of acting only on adequate and convincing evidence. Any present
judgment of the value and safety of this method is tentative. Therefore, to ad-
vocate it, except as an experiment, is premature and economically a gamble.
•'The waterworks profession's greatest responsibility is acting only on scien-
tific, adequate, and convincing data. To advocate the fluoridation of all w^ater
supplies is premature and unscientific. Fluoridation remains an experiment.
The simplicity of using the water supply as a vehicle for fluoridation and ad-
ministration of other proposed correctives and diet deficient treatment is a
temptation, but the policy invites serious trouble that should be resisted by the
personnel of the waterworks. Deficiencies of fluorine as well as calcium,
phosphorus, vitamins, etc., if prescribed anywhere, should be in the diet and
not in the public water supply."
We find in Paterson, (N. Y.) p]vening News, November 6, 1953:
"Dr. Leonard A. Seheele (Surgeon General) in discussing mass application
methods for preventing noninfectious diseases, said a case in point was fluori-
dation of public water supplies to reduce tooth decay. Such a communitywide
attack on 'far more serious diseases than dental decay probably wull be forth-
coming after laboratory tests have paved the way' he predicted."
The Missouri conference saw this was coming in 1951. I do not yet know if
cancer or heart disease will be the next to receive water treatment. Kidney,
liver, and nervous diseases will follow, then all diseases will be treated by the
public water systems. The time to stop saving teeth and treating all the other
diseases by using the water systems is now in my opinion. Let doctors and
dentists practice their professions.
94 FLUORIDATION OF WATER
WHAT OTHERS THINK ABOTJT FLUORIDATION
Winifred M. Sykes, British Housewives League :
"Compulsory mass medication is immoral, whatever the argument for any
particular medicine may be. It is against the internationally accepted prin-
ciples which govern medical experiments on human beings. It cannot be justi-
fied by quoting enforced addition to our food in the past. The freedom to cbor>.«!ft
or refuse is fundamental."
J. McFarland Forbes, journalist :
We find in a recent issue of Health for All, London, England :
"The basic assumption on which the whole case of fluoridation is founded,
that the addition to water of sodium fluoride, sodium silico fluoride, or hydro-
fluoric acid in the precise equivalent of similar concentrations of naturally
occurring fluorine compounds (usually calcium fluoride) is completely false.
"Charles Dillon, D. D., S. L. D. S., Fort AVilliams, found that sodium fluoride
reacts progressingly upon bone in extremely low concentrations, while calcium
fluoride does not react but is progressively absorbed. Dr. Dillon remarked:
'This is a completely new statement of the facts which has not even been
touched upon by those who are ready to consider their work so satisfactorily
complete that they are now prepared to fluoridate the water supplies of the
whole world.' I would like to see this quotation in letters of fire burning
over every city hall where councilors are toying with the idea of fluoridalion.
I suggest that rat poison should be used on rats and that human beings be
allowed to drink fluorine-free water."
All universities where extensive investigation has been made on animals and
children do not issue bulletins which shows that fluorine prevents decay. Just
the opposite, they show destruction of not only the teeth but all organs of the
body. I refer you to bulletin No. 45, University of Arizona. Eighteen pictures
of animals, four of children whose teeth shows destruction by fluorides.
University of New Mexico, No. 349 :
This work is most complete showing parts per million fluorine content of
every village and city and the effects upon children, animals and bones, called
The Menace of Fluorine to Health.
The Cornell Veterinarian, volume XLII, No. 2, Ithaca, N. Y., State College, by
D. .J. Jdall and Keith Keller :
Fluorosis in cattle. — This work shows the effects of fluorine on cattle, how
it destroys teeth, bones, and the reproductive organs, stunts the growth, causes
diarrhea. Cows have estrum every 9 days and bulls are unable to breed after
eating fluorinated food, about 3 months. An excellent bulletin for women to
learn how to keep a family small.
The Agricultural Department issues bulletins on how to destroy worms in
pigs, No. 274, which informs the farmer not to feed fluorine to breed sows ; 1 dose
kills the worms in nonbred hogs ; 1 dose kills the little pigs in bred sows ; our
Health Department in Washington recommends fluorine for our wives. Ergot
and fluorine was sold years ago for abortion purposes. Laws have been passed
making it a criminal act to sell it.
It has been a Federal crime to place any nonnutritive or deleterious substance
in food offered for public sale, the quantity of fluorine thus used was irrelevant.
I point you to Leo Kaufmann, at Boston. All he did was to pass some beer,
containing a little fluorine, over a State line. He was heavily flned. Now the
Federal law has been changed making what he did lawful but our officials have
not returned the $10,000 fine paid by Mr. Kaufmann. Think it over.
This conspiracy to place fluorine in the water is worldwide. Who is behind
it? Chemical and machinery manufacturers of the aluminum industry for one
purpose only — to make money. Many hundreds of our citizens have become
incensed at the arrogance of public officials, doctors, dentists, and others who
demand by law that we must open our mouths and swallow potent poisons
because they think it is good for us ! We have published numerous leaflets,
brochures, pamphlets and books all pointing out the damage that fluorine
causes. The Civil Defense had a conference with the Health Department over
6 months ago. What was said is still secret but Val Peterson, civil Governor,
has issued two warnings, August 5, 1953, to the press and November 29, Collier's
Weekly on the poison gas of fluorine. In spite of this, the promotion of fluo-
rine continues — an absolute hoax. The following letter is an example of many
received from all over the world :
FLUORIDATION OF WATER 95
Leo Spira. M. D., Ph. D., New York City, N. Y :
"As a medical man, I have no hesitation in stating that the principle of adding
a potent poison, such as fluorine is, to the public water supplies runs counter
to every clinical, physiolo.sical and pharmacological doctrine and should he
categorically rejected by all means at the disposal of civilized man."
The question of being compelled to eat or drink what public officials think
might be good for us, came recently when medics and dentists decided they
have higher intelligence and on that account, should dictate what we should
consume.
We do not feel that anyone should have the power to compel us to consume
that which we do not want. We desire to exercise our right of choice. That
is fundamental to liberty and freedom. If denied that choice, we are no longer
free men.
W. R. Cox :
"Put fluorine in our water? May God give us the strength to investigate and
understand authorities and experts who are, day by day, slowly and surely
causing us to demand our destruction."
On June 1, 1863, the Emancipation Proclamation came into force and all
men in bondage were made free. Now gradually, as Plato warned, we are
being ruled by evil men — those who have no regard for their fellows beings
and, if this program works with fluoridation, our freedoms will disappear, one
after another, then we may remember our American history and few may recall
those words of Patrick Henry but it will be too late.
The time to stop these procrime conspirators is now.
STATEMENT OF MRS. HUGO FRANZEN, SAN FRANCISCO, CALIF.
The Chairman. Mrs. Hugo Franzen, 767 San Bruno Avenue, San
Francisco, Calif.
Mrs. Franzen. Mr. Cliairman and members of the committee,
thank you for the honor and privilege of being here.
The manner in which the poisoning of our water supplies with
fluorides was put over in San Francisco — by the usual methods — pro-
vides an excellent example as to why Federal legislation is necessary
and urgent to stop this scheme.
George Heard, D. D. S., for many years a dentist in Hereford, Tex.,
called the "town without a toothache," stated in a letter to Mr. Roby
C.Day, May 15, 1954:
I believe that fluorine does, in a mild way, retard caries, but I also believe
that the damage it does is far greater than any good it may appear to accom-
plish. It even makes the teeth so brittle and crumbly, they can be treated only
with difficulty, if at all. It is hellish and un-American to put poison in city
water supplies and force citizens to drink it. I sincerely hope that at least
some of your dentists are cooperating with you in getting the truth about tooth
decay over to your citizens.
The methods used in this city and other cities, to put over fluorida-
tion, are equally hellish and un-American.
Before election in 1951, a local dentist publicly opposed by having
his name on a little card against proposition M (fluoridation). Sud-
denly he was silent; after election, he informed me, when some mem-
bers of the San Francisco Dental Society noticed his name, the secre-
tary of the society came to him and threatened him, stating that if he
further opposed fluoridation in any way, they would prevent him from
ever again obtaining insurance reasonably and force him out of
dentistry. This they could do, he stated, and so he was silenced, just
as numerous others have been silenced. The medical and dental so-
cieties in this city, I am informed, keep their members in line in this
96 FLUORIDATION OF WATER
iiuiiiner. My 3 ^-ears spent in opposing this selieme, confirm that
statement.
Apparently, section 20 of the code of ethics of the American Dental
Association, prevents any opposition — it reads as follows:
Sec. 20. Education of the Public. — A dentist may properly participate in a
program for the education of tlie public on matters pertaining to dentistry pro-
vided such a program is in keeping with the dignity of the profession and has
the approval of the dentists of a community or State acting through the appro-
priate agency of the dental society.
Where is our constitutional o-uaranty of freedom of speech?
In April of 1951, the finance committee of our board of supervisors,
C'liairman Chester McPhee and Supervisors Don Fazackerley and
Dewey Mead, scheduled a 2 p. m. hearing on fluoridation, to which I
was invited to attend and oppose. A short time before the noon hour
of that day, I discovered that the hearing had been set up to 1 p. m.
without our knowledege.
At this meeting, Sidney Epstein, D. D. S., representing the San
Francisco Dental Society, stated among other inaccuracies, that
Springfield, Mass., was fluoridating. I had just read a letter from
Paul Manning, D. M. D., LL. B., Springfield, written to Gov. Earl
Warren of California, asking for an equal opportunity for opponents,
stating that Springfield was not fluoridating and giving the reasons for
not doing so.
From the action of the committee, I had to conclude that they
assumed the opponents were wrong. A letter to the mayor of Spring-
field would have quickly confirmed the accuracy of my statement.
I can only assume that until quite recently, perhaps, no investiga-
tion was conducted to ascertain the accuracy or the truthfulness of the
statements of the fluoridators.
Someone had to be wrong.
It appears the opponents were condemned without investigation — ■
this procedure has continued the past 3 years here.
In December of 1953, Supervisor Francis McCarty introduced an
ordinance which would authorize the extension of the fluoridation pro-
gram throughout San Francisco. We opposed, with tlie results re-
corded in the following attached copies of letters and comments.
San Francisco II, Cat.if.. April 7, WoJf.
Hon. Francis McCarty.
Memher of Public Utilities Committee, City Hall.
Dear Sir: Although the question of extending the tiuoridation program in the
city and county of Saii Francisco has l)een returned to your coinniittee for fur-
ther hearing, I am advised tlirnugh the news])ai)ers that no one will be peruiitt;'d
the floor who has been heard on this matter.
I wish to advise that last night over station on KGO. a broadcast was made of
a portion of the debate i>y the lioard of supervisors on the subject of flnoridation.
This broadcast was heard by many thousands of citizens of San Francisco, dur-
ing which debate I was seriously misquoted by Supervisor :McCarty. very much
to my detriment and to the detriment of the cause I represent.
In the interest of fairness, honesty and integrity of the board of supervisors,
I demand that on Monday next. I be given the floor of the board of supervisors
for the purpose of pointing out these misquotes and correcting the errors for
the record, and for the beter information of those members of the board of su-
pervisors who have never heard the full story against fluoridation.
Yours very truly,
Mrs. Hugo Feanzen.
FLUORIDATION OF WATER 97
S.vN Fran('I.-(o 10. Calif.. I/>/// li. tU'i'i.
Hon. Gkobge Christophek,
President, Board of Siiixrvifiors, iiaii Fraiicisro, Culif.
Dear SiK : I am issiiiiiif this prote.st a.^ a citi/en and taxpayer ajiaiiist certain
statements l).v Supervisors Francis McCart.v and Mattliew Carberry durinii the
March 81. '[U7A. hearinj;- of the pnl)lic utilities coniniittee on fluoridation and
the April o meeting of tlie hoard of supervisors.
Supervisor iMcCarty. in answer to one of the opponent's ipiestions — why the
coniiiiL; March 81 hearing- 1 ad n(it been prblicized in <irder tluit those who wisli
to oppose or he present could atfend — stated that the hearing liad been widely
l)ublici^ed by our newspapers. Supervisor McCart.v made this same statement
before the board meeting;.
I contacted iMrs. ^\ arren Fon.i of the San Francisco F]xaniiner, ]Mr. Stewart
Uasmussen of the San Francisco Cali-IUilletiu. the San Francisco News Library,
]\Irs. Lin.u'le of the San Francisco ( hronical and .Mr. Griffith of the San Fran-
sisco I'rotiress.
All stated there bad i)een no notilication of that coming liearintr in any of
their newsi)apers.
Supervisor Carherry stated t(» the board of su])ervisors. and I quote: "I
asked the cpitstion if a local, (pialilied doctor or dentist would or had made a
statement on the .-ub.lpct opposjim fluoridation as bein.';- harmful and T was told
no such iierson (pialitied would make siich a statement.''
1 (piote Supervisor ]\IcCarty as he referi'ed to the same statement: '"Is tliere
one doctor of reputation in the city and county of San Francisco or one dentist
that you can name who is opposed to tluoi-idation';' The answer was "No."
P.oth statements are false.
Supervisor Carherry asked me if there is any doctor or dentist in this city who
oppased fluoridation that I could .^et to come before tlie conunittee and oppose
fluoridation. I answered "No," but attempted, unsuccessfully, to explain that
answei-. Both su]X'rvisors discounted and disqualified any information iiiven
by those who are not doctors, dentists, etc. Facts are facts and truth is truth,
regardless of whether a layman or professional peojile state those facts. The
opponents feel this board of supervisors should understand why no doctor or
dentist from this city and county is willinii' to oppose fluoridation before a ccnu-
mittee or publicly. There are doctors in this city who even warn their own
patients not to drink the poi.soned water, but they dare not oppose publicly. I
thorou.s'hly explained this situation to Supervisor Carherry, by ph<me. after the
March 31 hearing and liefore the April 5 board meeting. One dentist in this
city told me that he had been threatened and silenced because he opposed
publicly befor election. He (Supervisor Carberry) made no I'eference to it,
however, at the iioard meeting.
The opponents object to certain statements made by Supervisor McCarty in
summarizing the opposition. I quote: "As far as I am concerned, I think the
merits are all in favor of fluoridation."
In the spring of 19r)2, the Delaney congressional investigating committee
conducted extensive hearings on fluoridation. Eighteen scientists, testifying un-
der oath, presented both sides. That conunittee issued a final report and warned
go slow on fluoridation. I quote from that flnal report. Union Calendar No. 7S7 :
'•The committee believes that if connnunities are to make a mistake in reaching
a decision on whether to fluoridate their public drinking water, it is jtreferable
to err on the side of caution."
I (|uote Congressman A. L. Miller, M. 1)., former health director of Nebraska,
one of the Delaney conunittee, in the March 24, 1952, Congressional Record:
'•* * - despite my best efl'orts. and from the evidence before my conunittee, I
cannot find any public evidence that gave me the impression that the American
Medical Association, the Dental Association, or several other health agencies,
now recommending the fluoi'idation of water, had done any original work of their
own. These groups were simply endorsing each other opinions * * =\ There
is no scientific basis for recommending immediate acceptance of the projiosals
to treat the entire population with flu<n-ides. The mass medication of fluorides is
still in the experimental category * * * the Department of Agriculture has
recommended that no fluorides be fed to brood sows. Experimental work on rats
and mice imliciites a lessened mental reaction in i-ats and mice who have had
fluorides,"
In view of the flnal reports from this congressional investigation, the oppo-
nents believe Supervisor McCarty can present no justittcation of his state-
98 FLUORIDATION OF WATER
ments from any competent authorities on this subject that the merits are all iu
favor of fluoridation.
Supervisor McCarty, summarizing our city health director Ellis Sox's state-
ments said : "There are no findinss based on comiietent evidence that there
is any deleterious effect on anybody."
This, too, is false.
I quote an excerpt of a letter from Carlton F. Urehmer, D. D. S.. 809 North
High, Sheyboygan, Wis., dated October 21, 1953 :
"It has been about 7 years since this poison was quietly dropped into Sheboy-
gan's drinking water. Now people are calling more frequently for prophylaxis,
and when they come in. and I see the typical brown and white stains I have to
explain that these are unremovable and caused from the doctored water they
di'ink. This is a serious disfigurement to those who are interested in their looks.
"What it does to them, further inside, is a question I leave to them to think
of. I hope they go home and do think and will, one day, bring the question
of fluoridation to a vote here."
Mottled teeth is the first visible sign of fluorine poisoning.
We, opponents, object to the statements of Dr. Ellis Sox, that fluorine is not an
acciimulative poison. All standard reference works on fluorine state otherwise.
Di'. Sox, we believe, can give no verification from qualified scientists in the highly
specialized field of fluorine for that statement.
The opponents have repeatedly stated that fluorine is an accumlative poison
and offer the following verification for that statement :
The American Veterinary Medical Association, without question, maintains one
of the outstanding research organizations among medical groups. The following
was prepared by a committee on nuti-ition. I quote the American "Veterinary
Medical Journal, June 1943 : "Most of the flucu'lne ingested by animals is depos-
ited in the bones and teeth, the fluorine content of which increases in proportion
to the amovmt and duration of the intake. The continued intake of fluorine
finally leads to a saturation of bones and teeth, so that they are no longer able to
absorl^ this element from the blood and the tissue fluids. It is then that the
toxic effects of fluorine become apparent. * * * The fluorine content of the soft
tissues also will increase, even on very moderate levels of dietary fluoi'ine and
eventually these minute accumulations may induce degenerative changes in the
Ividneys and even the liver, adrenal glands, heart, and central nervous system
* * * * after the symptoms of poison appear, it is too late to do anything."
Chemical analysis was made of some hearts of heart-death victims in one of
the guinea pig fluoridated cities. One heart contained 80 parts per million
fluorine.
I quote the following from an English Dental Journal, Fluorine and Dental
Caries, by Charles Dillon, D. D. S., I>. D. S., from the Dental Practitioner, Vol.
111. No. .3. November 1952 :
"Dr. Dillon, on the basis of data obtained after extensive research into the reac-
tion of teeth and other bony structures to fluorides, is opposed to fluoridation of
public water supplies.
"He demonstrated, that the fluorine content of teeth may run as high as 112
to 580 parts per million without mottling l)ut with marked decay. The concen-
tration of fluorine in the teeth of one individual was 340 parts per million while
the adjacent jawbone contained 800 parts per million. He also was able to
show that there is a difference in the way different fluorine compounds affect
the bones. Sodium fluoride is particularly toxic, since it progressively displaces
the bone phosphate.
Dr. Dillon states that "the accumulative effect (of fluorides) has not been
adequately considered, nor can it be assessed withoxit further specific studies
directed to that end alone." He further concludes that "if the doctor pre-
scribes a drug that is known to have an accumulative effect, he should always
set a time limit to his medication just in case the cure becomes worse than the
disease."
Quote the United States Department of Agriculture Yearbook, 1939 :
"Fluorine interferes with normal calcification of teeth during their formation,
so that affected teeth, in addition to being usually discolored and ugly in ap-
pearance, are structurally weak and deteriorate early in life. For this reason,
it is especially important that fluorine be avoided * * *. Correlation studies be-
tween the occurrence of mottled enamel and the fluorine concentration of water
consumed afflicted persons show that this dental disease is always found when
water containing as little as one part per million fluorine is used continuously
during the period of formation of the teeth."
FLUORIDATION OF WATER 99
I quote Funk & Wagnalls New Standard Dictionary :
"Fluorosis, a disease coming from the ingestion of too much fluorine, is a
well established toxicological entity, characterized by increased fragility of
bones, due to their atrophy, and interestingly enough by enamel defects in teeth,
exposing them to early decay, i. e., producing the very opposite effect to that
which fluorine addition to drinking water is to achieve."
In the face of this data, we demand that Dr. Sox either offer some proof of his
statement that fluorine is not an accumulative poison from a recognized authority
in the fleld of fluorine and fluorine poisoning or publicly retract that statement.
I quote Supervisor McCarty :
"I feel it is about time that someone would take a stand in defense of decency
and integrity. I state the attack upon the medical, legal, and upon our health
services was made in the most violent and equivocal language."
We demand that this board of supervisors take a stand in defense of decency
and integrity, obtain a copy of the report which I gave at the March 31 hearing,
flled with the public utilities committee, and read at this board meeting. Super-
visor McCarty's statements cannot be reconciled with the report which I read.
I quote Supervisor McCarty:
"Now. the medical and dental associations and the officials of our State, local,
and national health associations have been, in my opinion, the victims of the
worst kind of abuse and slander, if you will, in this. And I stated at the com-
mittee hearing that I was a layman and I couldn't conclude whether fluoridation
is good, bad. or indifferent, and naturally, in reaching a conclusion in that mat-
ter, I would rely upon doctors, dentists, biochemists, and health officials in the
Nation and the State and the city and county of San Francisco. And as far as
T was concerned, I have implicit confidence in the integrity of the medical and
dental associations and our National. State, and local health bodies and I feel
that statement not only should have been made, but probably should have been
made long before this, in the face of the most vitriolic, violent, and unfounded
attack upon the people who guard' the health of our great country and upon our
Government and upon our press and upon our newspapers."
We agree with Supervisor McCarty that "the worst kind of abuse and slander,
if you will," has been heaped on the victims, but we don't agree with the super-
visor on the identity of the victims. We contend the opponents are the victims — ■
not the proponents — and offer the following proof :
I quote from a letter by Congressman A. L. Miller, M. D., former public health
director of Nebraska, dated May 8, 1953 :
"Many have asked about fluoridation of water in the District of Columbia. I
did introduce a bill in 19.51 to make this possible. After hearing the experts
on the subject, I withdraw the bill and apologized to my colleagues for intro-
ducing the measure. I was misled by the Public Health Service, .iust as many
are now being misled. The District officials, without authority from Congress,
proceeded to order fluoridation of water. They should have had legislative
authority."
Secret information uncovered by a west-coast Congressman, which was not
available to the Delaney congressional investigating committee, can prove to
anyone of average intelligence that the opi>onents — not the proponents — are
"the victims of the worst kind of abuse and slander, if you will."
After studying this secret information, one can easily understand why the
opponents — composed of laymen, professional people, and the most eminent
authorities on fluorine in the world, who, usually at great personal sacrifice —
are tidying diligently and desperately to guard the health of our great country
and the generations to come — so that there will be generations to come; it is
easy to understand why the opponents, who have become "the victims of the
worst kind of abu.se and slander, if you will" using Supervisor McCarty's words,
are the targets of the most vitriolic, violent and unfounded attacks from those
who have been entrusted to guard the health of our great country, among them
Supervisor McCarty.
Furthermore, this secret information records the words of the top echelon
fluoridators. including our United States Surgeon General Leonard Scheele, as
they plotted against the health, well-being, yes, the very lives of our American
people and against our constitutional freedoms. This information explains in
detail, the blueprint for misinforming and deceiving our citizens, for preventing
the truth from being disseminated, for taking care of the opposition — as Super-
visor McCarty took care of us — and for putting over fluoridation. The fluorida-
tors execute the blueprint quite well.
100 FLUORIDATION OF WATER
I quote excerpts from the fourth anuual <'onfereuce. State dental directors,
with the Public Health Service and the Children's Bureau, Federal Security
Building, Washington, D. C, June 6-8, 1951 :
Francis Bull, D. D. S., State dental director of Wisconsin, addressing the
conference stated :
"I don't know why they [meaning the antifluoridators] didn't include a let-
ter from two-thirds of the deans of dental schools and universities saying that
fluoridation is rat poison and should not be used. * * * We are living down
a lot of past history a lot of us helped create. These fellows can take the state-
ments of the American Dental Association or the United States Public Health
Service or the deans of dental schools or research workers * * * and they can
prove to you that we are absolutely crazy for even thinking about fluoridation
* * * there is no way of avoiding it * * * Do not tell the peoi)le that you
are just starting on the fluoridation program in order to promote something
else. * * * Sure fluoridation is wasteful, but unfortunately we do not know
of any other way of doing — them." And "When tliey take us at our own word
they make awful liars out of us."
Doing them. Could it be the deliberate sabotage of the mentality or the setup
for the quick liquidation of our people Dr. Bull referred to as "doing them"?
Mr. James Rorty, famous food investigator, thoroughly investigated this
great controversy. I quote from his article. The Truth About Fluoridation,
printed in the June 29. 1953, Freeman. "But the intolerance of the flu(n-idators
and their reckless slander of their opponents * * * all this is disturbing, to say
the least."
We feel it is obvious, from the preceding infv>rmation, that the opponents —
not the proponents — have been "the victims of the worst kind of abuse and
slander, if you will."
We demand that Supervisor McCarty correct his misquotes and errors, and
apologize for his slanted and biased summary of the opposition and his unfounded
and unwarranted attacks on us.
We also protest Dr. Ellis Sox being given the opportunity at the April 7 hearing
to rei^at his previous views that fluoridation is safe and beneficial. He appeai'ed,
not as an unbiased and competent authority on fluoridation, but as a vigorous
proponent. Supervisor McCarty announced at the April 5 boax'd meeting he
would permit no one to speak who had already spoken on the measure.
I quote Supervisor Carberry :
"The statement which I made to the opponents the other day in committee
meeting was well-intended, respecting the right of any minority to assert itself
and get a fair hearing before any board committee and before the board itself."
We now petition this board of supervisors to grant us a fair hearing, at least
1^2 hours for each side, before the board — not in committee. We want no recur-
rence of the public utilities committee hearing and no opportunity for any super-
visor to report back to the board his "version" of the opposition. Sacramento
City Council allowed 2 hours and 15 minutes for each side, then unanimously
rejected fluoridation — the second time that council had unanimously rejected
this scheme.
We contend the so-called mandate of the people should no longer be binding
upon this board of supervisors. We are prepared to compile a well-documented
reiwrt, which, we feel, will prove those contentions— that fluoridation was ))ut
over in this city by dishonest, treacherous, and un-American methods from the
very beginning, even to the election in which our citizens voted for fluoridation.
They did so, no doubt, due to the fraudulent, erroneous, and misleading state-
ments on our ballot arguments for fluoridation. Those ballot arguments for
fluoridation were approved by three supervisors — Mead, McMurray, and
Gallagher.
We brought to the attention of that board of siipervisors the fact that error
did appear on the ballot. This was simple to prove. I quote from our ballot
argument for fluoridation :
"6. Among those strongl.v urging the adoption of water fluoridation are those
groups dedicated to the health and well-being of the community — American
Medical Association."
We had in our possession tw<» letters from AMA. which refuted this statement.
We asked that the error be corrected or the proposition be withdrawn. Super-
visor Fazackerly, who introduced the ordinance, quickly referred it to judiciary
committee after election, so nothing could be done about it and the citizens
would vote with fraudulent, erroneous, and misleading statements to sruide
them. These same ballot arguments were printed in a newspaper.
FLUORIDATION OF WATER 101
Ever since election, the supervisors have stated they can do nothing about it
as it is a mandate of the people.
The l)<)iir(l of supervisor.s (leliborately permitted the people to vote on the issue
iiftei- th(> pr(»of had been presented that error did exist on the ballot. I say this
is an irre^Milarity in the election and the people are not responsible for voting in
fluoridation, 'liiey never were permitted to have correct information on the
subject.
As a matter of fact, the board voted to place it on the l)allot after they had
twice passed the ordinance for fluoridation. They did this, perhaps, because I
brought to their attention tlie fact that fluoridation is medication and clearly
stated as such in the April 1.", 10r>l, issue of California's Health, our State
I >ei)artnient of rultlic Health Kulletin, in which fluoridation is described as a
"preventive theraiieutic agent" — clearly medication. The final report of the
congressional coniniittee ( 1!)."2 i .stated fluoridation is "'mass medication without
parallel in tlie history of niedicine," and "still in the experimental categoi-y."
Yet. the proponents continue to state, erroneously, that fluoridation is not medi-
cation.
When the board passed the ordinance the second time, it did so because our
assistant director of public healtb, Dr. Erwin Sage, misinformed them when he
stated fluoridation is not medication. The board depended solely upon Dr. Sage's
advice.
Supervisor Mancuso. chairman of the judiciary committee, had stated if fluori-
dation is medication, every supervisor knows it is unconstitutional because it
woulil violate freeilom of religion guaranteed by the Constitution of the United
States. Medication (compulsory) is a violation of the religious beliefs of some
religious denominations.
Shortly thereafter we iiresented them witli the information of the California
Health Bulletin which describes fluoridation as medication. Supervisor Marvin
Lewis quoted from tbat bulletin to the board and said every supervisor knows
now tbat fluoridation is medication and unconstitutional and if it is forced on
the ballot, they do so knowing it is illegal and unconstitutional. The supervisors
did it anyway.
tinder these circumstances, we feel the fault is one of the city fathers, not the
fault of the voters. Every supervisor should be acquainted with the full facts
before voting to extend the program.
We believe, in the interest of fair play, honesty, and integrity, this board of
supervisors has no choice but to grant the hearing and give the opponents the
opi)ortunity to correct the mis(iuotes and the errors and publicly defend our cause
against the unfounded and luiwarranted attacks by Supervisor McCarty.
^'ery truly yours,
GOLDA Franzktv.
Attention of the Interstate and Forei<iii Commerce Committee to
the folloAvino; comment re<«;ardinfj the preceding- letter : I reqnested
that tliis letter be read to the members of the board of supervisors.
The resnlt — the board took more time preventing the letter from
being read than it vvonld have taken to read orally as requested. No
action was taken on my request for the privilege of the floor.
San Francisco, Calif., April Ji), 19-j.'i.
Hon, George Christopher.
President, Board of S!)ipc)-risors,
Sati Fraucisco, Calif.
Dear Sir : During the April 12, liri4, boar<l of supervisors' meeting, the deputy
city attorney, in answer to Super\isoi- P.yron Arnold's question, stated the
board of supervisor's could stop the fluoridation program if it was shown that,
instead of being a measure to protect the public health, it had become a pro-
gram which is detrimental to public health.
Enclosed is a letter from a competent medical doctor practicing in this city,
a physician and surgeon with over .")0 years' experience, which states one of his
patients has been greatly harmed by using the fluoridated water. There are
many others, but one case is sufficient.
Notice the postscript, please. Dr. Gould's office is not supposed to be in a
fluoridated area, but Mr. George I'racy. snijerintendent of tbe water company,
verified for me the fact that the fluorides bad "seeped" to other parts of the
water system — not just the sections which were supposed to receive fluorides.
102 FLUORIDATION OF WATER
We opponents, therefore, respectfully request that the fluoridation program
be stopped quickly, before more damage is done to citizens of this city.
Very truly yours,
GoLDA Feanzen.
The April 19 letter was read at the board meeting. The ordinance
was passed without comment, by unanimous vote. The opponents
were given no opportunity to correct the misquotes or inaccuracies.
I now quote excerpts from a report which I had prepared to use,
had I been given the privilege of the floor at the April 12 meeting of
the board of supervisors :
The information which I shall use, explains why we feel that Supervisor
McCarty, rather than conducting a fair hearing — then giving an impartial,
unbiased report to the board of supervisors on the opposition — chose to give a
slanted, inadequate report with misquotes and errors.
I read from the Third Report, Un-American Activities in California, 1947,
page 79. "Sponsors of the California Labor School included * * * Francis
McCarty, hearing commissioner for OPA."
The California Labor School, I am informed, has been cited by the United
States Attorney General as a subversive organization.
I read from the Fourth Report, Un-American Activities in California, 1948,
Communist Front Activities, page 172. "Haakon M. Chevalier, accompanied by
his attorney, Francis McCarty, appeared and testified before the committee
at its Oakland hearings, November 6, 1947. While his memory was apparently
faulty in many respects, he was able to recall some of his affiliations in Com-
munist-fronts and Communist activities."
If I were a Red, pink, or fellow traveler, I would never be unwise enough to
choose a loyal American for my attorney. By the same token if I were a loyal
American, I would never be foolish enough to choose a Red, pink, or fellow
traveler for my attorney, if I knew it. Patriotism and communism are dia-
metrically opposed.
I am informed that Supervisor McCarty is that same Francis McCarty. He
lacked the skill to detect communism in operation in the San Francisco Labor
School. Would he be any more skillful in detecting communism in action in
fluoridation?
We submit the following information to show just and logical
reasons for our increasing alarm and determination to stop this
hellish and un-American scheme:
United States Surgeon General Leonard Scheele, greeting the
fourth Annual Conference, State Dental Directors, with the Public
Health Service and Children's Bureau, Federal Security Building,
Washington, D. C, June 6-8, 1951, said :
I have just come back from the World Health Assembly * * * Obviously, one
of the biggest things facing us is the catalyzing of a real national program of
water fluoridation.
Did Francis Bull, D. D. S., State Dental Director of Wisconsin, an
avid fluoridator, expose the political scheme when he told the con-
ference :
Do not tell the people that you are just starting on the fluoridation program
in order to promote something else * * * Sure, fluoridation is wasteful, but,
unfortunately, we do not know of any other way of doing * * * them.
Doing * * * them — doing * * * them. After spending over 3
years in the trenches opposing this scheme, perhaps I can throw
a little light on those words "doing * * * them." What is the "some-
thing else" Dr. Bull referred to? Could it be the deliberate sabotage
of the mentality, or the quick liquidation of our people? ^ Could such
a program be honestly termed as anything but chemical rape or
chemical warfare?
FLUORIDATION OF WATER 103
I quote Harold D. Lasswell, The Garrison State, from the American
Journal of Sociology, 194:1 :
Still another factor darkens the forecast for the bottom layers of the popula-
tion in the future trarrison state. If recent advances in pharmacology continue,
as we may anticipate, physical means of controlling response can replace sym-
bolic methods. Tills refers to the use of drugs, not only for temporary orgies of
energy on the part of frontline fighters, but in order to deaden the critical func-
tion of all who are not held in esteem by the ruling state.
Perhaps we read it and payed little attention.
Gentlemen, if an intruder forced his way into your home, attacked
your daughter and forced his way into her body, would you stand
idly by and permit this to happen, or would you attempt to stop it?
I am certain you will agree that any courageous and honorable father
would protect his home and family against any intruder or attacker.
If the father killed the attacker in attempting to protect his family,
I believe you will also agree that no honest or honorable jury would
ever convict that father, rather, they would commend him. I believe
it would make no difference to you if that would-be rapist were an
ofKcial from the public health departments, the medical associations,
the dental associations, clubs, organizations, your family physician, or
3'Our best friend — you would believe he had gone mad and would
attempt to stop him, even if it meant killing him. His position and
identity would mean nothing to you at that moment; you would
judge alone by his actions, and rightly so.
Now, suppose that instead of using a door or window for entry, an
intruder used the public water mains for forcing his way into your
home and the mouth and skin for forcing his way into the body. In
trying to find a word which will most adequately and accurately de-
scribe what we feel is happening by injecting our public water sup-
plies with this most violent poison to all living tissues — flourine — we
can find no better word than rape. Perhaps that w^ord is technically
incorrect, but some high-sounding opinion from a so-called authority
would not change that feeling.
I am certain that you are aware, just as we are, that prisoners in a
penitentiary cannot be used for medical experimentation against their
wills — at least, not legally. Fluoridation is medical experimenta-
tion— and defined as such by the Delaney committee. Wliy has there
been no invocation of the laws which protect us from medical experi-
mentation against our will.
I can think of no other way to invade and sabotage the homes and
bodies of trusting, unsuspecting, or protesting citizens except through
the public water supplies, can you'^ Is this not communism, totali-
tarianism, pure and simple, mass medication or mass treatment
through force, deceit, or coercion with total disregard of the dignity
of the individual or his health or life?
Mr. George Pracy, superintendent of the San Francisco Water Co.,
recently stated, that when the extension of the fluoridation program
in San Francisco is completed, the water supplies of the Peninsula
cities of San Mateo, Burlingame, San Carlos, Belmont, Millbrae,
Hillsborough, South San Francisco, Brisbane, Colma, Sharp Park,
Vallemar, Pacific Manor, Broadmoor, and some smaller unincorpo-
rated areas will also be fluoridated. Furthermore, Mr. Pracy stated
that the city government of San Francisco does not intend to obtain
permission from those city governments or by a vote of the people
104 FLUORIDATION OF WATER
before poisoning' their water supplies with fluorides. San Carlos
voted against fluoridation 2 years ago. The most recent elections in
California on this issue resulted in Livermore rejecting fluoridation
and Ukiah also rejecting by a landslide. As George Heard, D. D. S.,
stated :
It is hellish and iin-Aiuerican to put poison in city water supplies and force
citizens to drink it.
Here is an example of poisoning by secrecy and force.
Why has the United States Public Health Service opposed the use
of bottled water, tablets, and all alternatives to using the common
water supplies for dispensing this violent poison when at least six
other methods are available ? A year's supply of fluorides for a fam-
ily of 4 costs but 25 cents. Druggists can dispense fluorides by pre-
scription, for each individual in controlled dosage, something which
is utterly impossible if dispensed through the public water supply.
Let us reexamine Dr. Bull's statement :
Sure, fluoridation is wasteful — liut, unfortunately, we do not know of any
other way of doing * * * them.
Why has there been a complete lack of interest by the United States
Public Health Service and the American Medical Association to start
any reliable, scientific, verifiable, or repeatable medical investigation
of the toxic effects of ingesting water containing sodium fluoride?
And why is all such published research discredited or smeared ? Why
has there been complete silence in all United States Public Health
Service "scientific" literature and news items regarding the "brain-
washing" aspects of sodium fluoride ?
I quote from the Shreveport Journal, Shreveport, La., October 5,
1953 :
Dr. Joe D. Nichols, newly elected president of the Tri-State Medical Society,
said Sunday in a radio interview here, that he suspected Communist agents
of being behind the move to put inorganic fluorine in municipal water systems.
Nichols said tliat endorsement of the fluoridation program by reputable organi-
zations is merely chain reaction. The Lions endorse it, then the Rotary, then
the Jaycees, and so on in every community, because they have heard that the
others have done it. Communist agents, I have heard, have inflltrated the
United States Public Health Service. The United States Public Health Service
has mothered this thing and a lot of good doctors have been dui>ed into endors-
ing it. He added that if Shreveport puts fluorine in its drinking water, he
would "either skip the town or bring my own jug of water with me."
That physician dares to tell the truth, but it reaches so few of our
citizens.
I quote from H. M. Greene, M, D., from The Reminder of our Na-
tional Heritage,
Dangers of poison in artificial fluoridation by government are the danger in
mass medication by Soviet communism. We require license for doctors, nurses,
and druggists to give poison drugs. But, artificial fliioridation, for which there
is no antidote, is put in drinking water for children and agents of Malenkov,
now at liberty in the United States, can give poison to our children.
Perhaps the reason Dictator Ana Pauker was deposed in Red Ru-
mania was because she "let two cats out of the bag" when she boasted
to Princess Ileana of Rumania just how the United States is to be
taken over. Princess Ileana's book, I Live Again, quotes Ana Pauker
as stating that the take-over will be accomplished by taking over
(note — not destroying) of the utilities and by poisoning the water
supplies. Could she not be questioned concerning this statement ?
FLUORIDATION OF WATER 105
Quoting from the Los Angeles Times. January 7, 195-1 :
Six of niue public utility employees who appeared yesterday before tbe State
senate fact-flndingr committee on un-American activities here refused to answer
questions about Communist Party aflBliation on constitutional grounds.
Tlie Daily Palo Alto Times, December -21, 1953, recorded as fol-
lows :
Among- those receiving the Stalin Peace Prize was Prof. Singh Sokhey, mem-
ber of the Indian Parliament and Chairman of the World Health Organization's
Plague Committee.
AVould Prof. Sokhey have received that Communist award if he
had not been furthering the cause of Soviet communism? I think
not. And I understand our United States Public Health Service
cooperates with the World Health Organization.
Quoting from the Springfield Union, February 24, 1954:
Asks help for bills against fluoridation, Representative Gray's measures to
be heard in Boston next Tuesday. Mr. Gray was a member of the fluoridation
study commission which looked into the question last year. * * * "We know for
sure," Mr. Gray said, "that whoever the men, the powers, behind the fluoridation
scheme are, a number of them are operating worldwide." He says he has evi-
dence to prove that numbers of citizens of Australia, England, Germany, New
Zealand, and Scotland "are fighting the fluoridation scheme as hard as the citi-
zens of Massachusetts and the rest of the United States are fighting it. * * *
Certainly," he said, "all those people don't fear and fight without cause, particu-
larly those who liave been close enough to the Red menace to recognize the
danger signs."
A reading of Dr. Leo Spira's works indicate that medical personnel
rarely are able to recognize the effects of trace poisons, including
fluorides, and are prone to cover up — blaming other causes.
Only those we trust implicitly can betray us. Three whole profes-
sions— the medical, dental, and public health — stand indicted, be-
cause the few who control those organizations are, we feel, either un-
informed, misinformed, dishonest, or subversive. Into which cate-
gory do they belong?
The several hundred thousand people living in the guinea pig cities
of (xrand Ka]uds, Mich.. Newburgli, X. Y., and Sheboygan, Wis., can
answer for all time what really happens when human beings ingest
a steady dose of sodium fluoridated water for a number of years. We
have the qualified and honorable scientists necessary to conduct such
an investigation — Dr. Leo Spira, Dr. Paul Manning, Dr. Charles
Brusch, Dr. Alfred Taylor, Prof. H. V. Smith, and Dr. Margaret
Smith, from the University of Arizona, and others.
The citizens and taxpayers of this Nation, I am certain, want such
an investigation, though it may cost millions of dollars. What is
money in comparison to the health, life, or security of the Nation?
To date, a half dozen or so decisions favoring fluoridation and one
against, have been given.
Judge James U. Galloway, of the district court of Shreveport, La.,
ruled fluoridation illegal, stating tooth decay is not a matter of
public health, but one of individual concern.
A sweeping decision favoring fluoridation, was handed down Octo-
ber 22, 1953, by Judge Joseph A. Artl, of the common pleas court of
Cleveland. Judge Artl ruled that a —
person's constitutional right to treat his health as he deems best, and of parents
to raise their children as they deem best and to be free from medical experimenta-
tion and to exercise freedom of religion are all subordinated to the common good.
That children's dental health is properly a providence of community laws.
106 FLUORIDATION OF WATER
Does this sound like the decision from a judge of the United States
of America — or a totalitarian America ?
That decision means : We have just abolished the Constitution of the
United States ; all the divine rights of free men, as clearly stated in
our Declaration of Independence, our God-given Constitution with
the Bill of Eights — all the unalienable rights endowed by our Creator,
the right to say what is done to one's own body, the right to worship
God as one chooses — all this is destroyed now. From now one, we have
no right to a body as healthy as God bestowed, no right to a brain
undimmed and unimpaired, no right to bring forth children as healthy
and intelligent as the Creator intended. We are setting up classes in
disrespect of the American form of government — a ruling class and a
slave class. Sufficient years of forced feeding of sodium fluorides and
the change is complete — moronic, atheistic slaves, the direct result of
sodium fluoridation and ruled by a superior, intelligent few. Even
our unborn children cannot escape this direct assault.
Fantastic, unbelievable, impossible, you say ? Think again.
The only time anyone must legally submit to compulsory medica-
tion, under our American fomi of government, is when there is the
danger of an epidemic or emergency of a contagious or infectious
disease. Dental caries are not now, and never can be, honestly classi-
fied as contagious or infectious.
I quote from the San Francisco Examiner, February 27, 1954 :
Brown O. K.'s fluorides. Municipal water districts may add fluorides to their
water supplies to protect the health of consumers. Attorney General Edmund G.
Brown ruled yesterday. Approval of the State board of health is required,
however, Brown said in an opinion requested by Assemblyman Francis Dunn,
Jr.. of Oakland. Districts and their employees are free from legal liability in
the practice unless negligence is involved, he said. The opinion held that there
was no need for an amendment to the health and safety code for i>ermission to
add fluorides.
Quoting from the Oakland Tribune, April 22, 1954, Mr. Louis J.
Breuner, president of the board of the East Bay Municipal Utility
District, stated:
We feel the attorney general's opinion is an opinion of the law, but it wouldn't
hold up in court. It does not take us off the hook.
Section 20703 of the Health and Safety Code of the State of Cali-
fornia, defines fluorides soluble in water as poison.
Section 20751 makes it unlawful to vend, sell, give away, or furnish,
either directly or indirectly, any poison enumerated in section 20703
witliout a poison label.
Section 26286.5 forbids the advertisement of a drug or device repre-
sented to have effect on dental caries.
San Francisco's city attorney, Dion Holm, ruled fluoridation legal.
A Massachusetts brewery, prosecuted under the Federal Food, Drug
and Cosmetic Act, criminal proceedings, was fined $100,000 for having
a small amount of fluoride in its beer. The court nded fluorine a non-
nutritive, deleterious substance; the quantity was irrelevant.
The law does not apply to cities fluoridating, the Federal Secm'ity
Agency ruled.
"Wliat good is Congress — or the State legislatures — if the laws that
they pass to protect us are abolished by those who, perhaps, have other
plans?
FLUORIDATION OF WATER 107
We need a law which specifically prohibits the poisoning of our wa-
ter supplies witli fluorides and one which will protect citizens from
medical or surgical experimentation without their written consent.
Quoting f roVn the Sail Francisco News, February 23, 1954 :
St. Paul, Minn. — The President of tlie American Dental Association said todaj
the use of fluoridated water has cut the rate of dental decay among children by
as much as 65 percent. Dr. Leslie Fitzgerald of Dubuque, Iowa, told 5,000 dele-
gates to the Minnesota Dental Association convention here that 910 American
conmiunities. with populations totaling nearly 17 million, now add fluorides to
their drinking water * * *. The evidence continues to demonstrate that fluo-
ridation will iiave no untoward effect on the general health and will signiflcantly
improve health through the reduction of dental decay.
Quoting Francis Bull, D. D. S., from his address at their convention :
When they take us at our own word they make awful liars out of us.
Fortunately, ever-increasing numbers of citizens are learning the
truth — that the proponents are, by their own words "awful liars" and
protect themselves in the poisoned cities by purchasing unpoisoned
bottled water.
I have stated repeatedly — and I reiterate — that anyone who has any-
thing to do for fluoridation, is displaying a treacherous attitude for
one of four reasons — either because he is uninformed, misinformed,
dishonest, or subversive. Unquestionably, practically everything in
this Nation is infiltrated by Communists, subversives, and their dupes
or tools.
Seventeen million Americans, more or less, at the mercy of Soviet
Communists. Invasion and sabotage, by remote control, tlirough the
water mains. What could be more clever or effective ? Our enemies
take over — city by city.
I know that fluoridation is a Communist scheme — frankly, the mas-
ter plan — but I cannot prove it, for those who have informed me, can-
not testify — they would be liquidated, if they did. I believe you are
in a position to prove it, however, by having Princess Ileana and
others testify under oath.
The catalyzing of water fluoridation is being successful and millions
of American are being poisoned. I also believe that a Federal law
should be quickly passed to prohibit this scheme, in order to avert
further diseasing and perhaps killings of our innocent and protesting
citizens — and to prevent the complete loss of faith in this administra-
tion which so many are experiencing.
Enlightened and aroused citizens are demanding that his hellish
and un-American program be stopped — recent examples of what is
taking place on the fluoridation battlefront, as reported from La-
Crosse, Wis., April ft, 1954, fluoridation was rejected by a 10,623 to
2,356 vote. Cincinnati rejected by 20,000 votes, and the city councils
of Akron, Ohio, and Fort Worth, Tex., deemed it advisable to rescind
their former action to fluoridate.
To you, gentlemen, I throw the torch — the torch of divine justice,
individual dignity and liberty under law — our light to the rest of the
world, the hope of all mankind. Be yours and hold it high and you
will help to usher in the dawn of the new age — peace on earth, good
will to men.
Thank you, gentlemen, for this privilege and honor. I leave our
constitutional Republic under your loyal protection, now that we have
given you the facts.
49391—54 8
108 FLUORIDATION OF WATER
The Chairman. Mrs. Fraiizen, we appreciate your having come a
long distance to present yonr views to this committee. We realize
that you have spoken with sincerity and that you are convinced as to
the right of your cause or you would not have come as far as you
have and you would not have spoken with the positiveness that you
have. We appreciate your having been here, and assure you that your
statement will be given our very careful consideration.
Mrs. FrxXnzen. Thank you, Mr. Chairman.
I forgot to state that there are approximately, I would say, 100,000
people — there were 90,000 votes against it in San Francisco and they
had but one side, and that was the ])ro side.
I am speaking here not representing the committee, but thousands
of people who have asked me to come down and represent them, as
they feel it, and fight it out on our battlefront.
The Chairman. I wish they could have been here and heard you,
and the manner in which you have spoken in their behalf.
Mrs. Franzen, Thank you.
STATEMENT OF MISS LILLIAN VAN DE VERE, PRESIDENT OF THE
CITIZENS' COMMITTEE AGAINST FLUORIDATION, AND CON-
NECTICUT PURE WATER ASSOCIATION, HARTFORD, CONN.
Miss Van de Vere. Mr. Chairman and gentlemen, thank you for
giving me this privilege of coming here to speak my little piece. I
will make it as brief as possible.
I am a laboratory research scientist, trained at the College of Physi-
cians and Surgeons; refresher course at Harvard, Thonidyke, Mass.
I have been doing anaphylaxis research for Prof. Hanz Zinsser, pro-
fessor of Bacteriology, College of Physicians and Surgeons, and later
at Harvard.
I am a registered bacteriologist. New York State. By civil-service
examination I was appointed research bacteriologist and assistant in
pathology. New York Health Department; also by civil-service exam-
ination appointed microbiologist, serologist, Hartford State Health
Department; member of the American Public Health Association;
Connecticut Public Health Association; World Health Organization;
American Association for the Advancement of Science. I am co-
author of a cancer research article published in the New York State
Medical Journal, have done fluoridation research with Prof. I. M.
Adler at the College of Physicians and Surgeons.
Dr. William H. Park, clirector of public health laboratories. New
York City, advised me as to the shortest method of attaining my ob-
jective. He said, "If you do not ever intend to practice medicine, but
want to do research work exclusively, you will lose a good many years
on academic studies which will in no way train you for the work you
want to do. There are plenty of doctors but not enough research
workers. You can get special courses in various laboratory techniques
which you will need, at the College of Physicians and Surgeons." I
was accepted as a special student and took all the laboratory courses.
More recently I completed a refresher course in hematology (blood
studies) at Thorndike Memorial (Harvard). I passed a civil-service
examination for research bacteriologist and I was the only woman
who passed the examination in histology. My marks were about 90.
FLUORIDATION OF WATER 109
I did laboratory research work with Drs. I. M. Adler and M. J. Sitten-
field at the College of Physicians and Surgeons. We had just com-
pleted our fluoride research work when I was appointed by the Civil
Service Commission as bacteriologist, etc. Later I became a regis-
tered bacteriologist by the New York State Board of Health. For
many years I did laboratory research and routine laboratory tests in
private laboratories and hospitals. My duties included bacteriology-
serology-biochemistry-clinical pathology, and tissue work. An article
in the New York Medical Journal (about spring 1932) reports a
study in cancer research by Dr. George Wyetli and I am coauthor.
Through a civil-service examination I was appointed as microbiol-
ogist-serologist for the Connecticut State Health Department. I left
there when I became ill. I am recovering from a bus crash injury.
I am a member of the American Public Health Association, (Con-
necticut Public Health Association, World Health Organization,
American Association for the Advancement of Science, and the Society
American Bacteriologists. I keep abreast of current achievements
in laboratory research by attending nearlj^ all scientific meetings.
I have written a textbook on fluoridation for which I have had re-
quests from dental colleges. My book is not yet published. It is in
the Library of Congress.
I submitted two antifluoridation bills in the Connecticut Legislature
last year which I believe helped defeat the profluoridation bills.
Our prime purposes for this research work was an attempt to find a
substance which might retard the onset of arteriosclerosis (hardening
of the arteries) . We had tried many reagents, with no success. Fin-
ally we thought that perhaps a very weak solution of sodium fluoride
might be effective since we know the specific affinity of fluorine for
calcium, inasmuch as arteriosclerosis is characterized by calcium de-
posits on the internal walls of blood vessels, we proceeded as follows :
For 30 days animals were fattened and observed by routine tests.
Then the experiment began. White rats, II/2 to 2 years of age. Food :
cracked corn, oats, beef suet. Distilled water for controls. Fluori-
dated water contained sodium fluoride. 10 parts per million, 5 part^
per million, and 1 part per million. Period of experiment up to 9
months. Inverted bottles with medicine droppers, rubber tubing with
pinchcocks insured consumption and no waste. Each day, amount
of food and water consumed was measured and recorded. Daily
bloodsmears (by snipping end of rats' tails) and blood coagulation
time were checked. Those rats which lived the longest, about 7 to 9
months, showed marked emaciation; loss of hair; calcareous deposits
in aorta, and generalized hardening of blood vessels; hemorrhagic
areas in liver, long bones (femur) were chalky in appearance; bone
marrow contained fluoride crystals, kidneys showed cloudy swelling ;
bloodsmears showed increased polymorphs (white cells) and bloocl
clotting time increased as compared with control rats' blood — (dis-
tilled water) and some few developed long chalky tusks. Control
animals, sacrificed — showed no pathology except varying degrees of
adiposis.
Observation : Instead of retarding onset of arteriosclerosis it seemed
to be accelerated. Repeated experiments corroborated these findings.
In the next set of experiments with white rats which had cancer
transplants (from Dr. Woglam and Francis Carter Wood of Columbia
110 FLUORIDATION OF WATER
University) we used distilled water for control animals, and fluori-
dated water, containing 10 parts per million, 5 parts per million, and
1 part per million, sodium fluoride on the experimental batch. Results
showed more rapid growth of neoplasm (cancer) in the rats which
drank the fluoridated water in all dilutions; with metastasis more
generalized. Testicular cancer grew most rapidly, the intraperito-
neal-x growth was not as fast. Cancerous growth developed faster
and larger than in the control rats which drank distilled water. Some
of the rats which drank fluoridated water died after 2 months; others
developed marked emaciation until death.
Conclusion :
Experiment I. Onset of arteriosclerosis was hastened by ingestion
of sodium fluoride; blood-clotting time was prolonged.
Experiment II. Cancer growth was accelerated by ingestion of sodi-
um fluoride.
COMMENTS ox FLUORIDATTOX BY PROPOXEX^TS OF FLUORIDATIOX'
Francis Heyroth, M. D., December 1952, Journal APHA :
Toxieological evidence in the fluoridation of public water supplies : "Any toxic
hazard that may be associated with fluoridation could he only tliat of the cumu-
lative action of small amounts taken daily over a long period of time. Variations
in susceptibility would make hazardous any attempt to predict the maximum
safe human intake. Like other biological functions, the ability to store or
excrete fluorides may be expected to vary from individual to individual.
M. F. Schafer, M. D., public health officer, Colorado Springs, Colo. :
In order to prevent dental fluorosis we are advising that our water be diluted
.50 percent with nonfluodidated water which is available at our dairies. (.Tanuary
14, 1952, communication.)
Geo. S. Bratton, impact of municipal Avater fluoridation on foods
and beverages, April 1953 :
It is the responsibility of the nutritionist to help build good teeth : it is the
responsibility of the dentist to help prevent dental decay, but it is dt finitely not
the duty of the water companies to practice preventive medicine or dentistry.
*or nutrition. Water containing 1 part per million, after boiling may contain
as much as 35 parts per million or more of fluorides.
Fred S. McKay, D. D. S., Colorado Springs :
The study of mottled enamel — summary and conclusions : The structure of
the enamel is determined only during the period of calcification and not there-
after (up to about age 8 years). Fish is one of the richest sources of natural
fluoride. It is, therefore, a matter of good nutrition and preventive dentistry
and medicine to include fish in the diets of all children up to 8 or 10 years
of age. Fluorine is present in a great many foods, but fish and tea contain the
largest amount. The usual foods eaten daily supply about 0.3 to 0.9 milligrams
fiuoride (McClure).
(Fluoridation has never been determined as a necessary element in
human nutrition.)
H. Trendley Dean (private communication) :
Reliable evidence must be available that the proposed fluoridating ag^jc will
not be injurious to health even when ingested as part of the daily diet over a
period of many years. With chemical additives to food on the increase, the im-
portance of that criterion cannot be overemphasized. (Journal ADA, February
1952.)
FLUORIDATION OF WATER 111
Zoller Dental Clinic, University of Chicago :
Article deals with germ-free technique. There is no dental decay in the ab-
sence of mierobic life —
in other words, a clean mouth is the answer to prevention of dental
decay.
Practicing dentists' viewpoint on fluoridation :
Many dentists regard fluoridation with skepticism, opposition, and indilfer-
ence. Dietary and nutritional habits, proper use of toothbrush, reduction in
intake of refined starches and sugars have been demonstrated to be good pre-
ventive methods which can be recommended to patients. These are in the same
category as fluoridation of municipal water supplies.
F. A. Bull, D. D. S., Madison, Wis. :
Pluoridation of communal water supply does not solve the problem of dental
decay ; nothing could be further from the truth. It will take 14 years before
dental caries reduction is brought about in children, and even after fluoridation
has been carried on for a long time, one-third of dental caries (dental decay)
will still exist. It is by no means a complete answer to the dental health
problem.
Cost of fluoridation of the Hartford Metropolitan District Water
Commission will be about a quarter-million dollars. In the fourth
annual conference, Dental and Public Health, Washington, D. C,
"Cost is about $50 per capita." Hazard to operator : He must wear
mask, goggles, breathing apparatus, dust collector, air filter, rubber
gloves, rubber apron, and so forth. No insurance company will give
coverage. Nobody will take responsibility for personal injury or
death. Health department says, "We onl}' recommend it." The water
company says, "We are only acting as agents, instructed to add the
fluoride chemical."
Report of ad hoc committee on fluoridation of water supplies. Na-
tional Research Council, Washington, D. C. An impartial report pre-
sented for professional, governmental, and civil groups who must
make decisions for their communities :
Summary and conclusions:
The most sensitive indication in interference with normal calcification of
teeth, and is esthetically undesirable. The level of fluoride concentration in
drinking water which causes this varies with the individual susceptibility and
with the amount of water consumed. How much reduction in dental decay will
vary with local conditions.
About one-half of the population of the United States lives in small
villages and rural areas and have no communal water.
Harold Hodges — Rochester :
Other ways to use fluorides for dental caries: Topical applications to teeth,
tooth pastes, and powders, mouthwash, fluoride chewing gum, vitamins with
fluorine. A possible future danger of mottled teeth lies in overenthusiasm to
prevent dental caries — people will take fluoride tablets, and they will eat foods
which have a high natural fluoride content, such as fish and tea. Conclusions :
Persons drinking communal water supplies containing about 1 part per million
of fluorine and by eating foods which contain fluorine may bring about a fluorine
level, sufficient to cause mottled teeth.
H. V. Smith, Arizona :
Evidence strongly indicates that any water with a fluorine content of 0.9 parts
per million or over is dangerous from the standpoint of probable damage to teeth.
Dr. Badger, New Mexico :
Mottled enamel in children drinking water containing 0.9 parts per million
fluorine. To cover up mottled teeth, a dentist can make porcelain jackets, crowns,
or even full dentures may be required.
112 FLUORIDATION OF WATER
In St. David, Ariz., most natives at age 24 years wear full dentures.
Natural flnoride in water contains less than 1 part per million fluoride.
American Medical Association: Testimony under oath, congres-
sional investigation, 1952 :
American Medical Association does not urge or recommend fluoridation of
public water supplies.
Xewburgh, X. Y.. experiment station, Dr. David Ast, dental
surgeon :
Final conclusions cannot he made at this time. It will require an additional
10 years of study to determine cumulative effects of fluorides in the body.
Grand Rapids, Mich. :
A report from the United States Public Health Service, Bureau of Vital Sta-
tistics : After 4 years fluoridation of public water supplies, deaths increased
from heart disease, almost 100 percent, deaths increased from kidney disease, 50
percent, deaths increased from brain diseases 50 percent.
Tlie population increased 8 percent. Does this sound like a recom-
mendation for fluoridation ?
J. C. Muhler and W. G. Schafer, department of chemistry and
School of Dentistry, Indiana University :
Decreased thyroid activity is related to increased carles susceptibility in the
rat. Dessicated thyroid reduces the incidence of dental caries to the same degree
as sodium fluoride alone.
FIA'OROSED TEETH EXITIBIT
Gentlemen, I would like to submit this exhibit for your inspection.
These teeth came from natives from Aurora, 111., where they have a
natural fluoride concentration of 1 to 2 parts per million, which is
considered as an ideal about of fluoride. Proponents of fluoridation
state that when water contains fluoride especially in the concentration
of 1 part per million, children will not have cavities in their teeth —
that only about 10 percent of children will have mottled teeth and this
is only a pearly whiteness, or perhaps a little yellowish coloring — and,
of course, this is prominent discoloration.
Gentlemen, these teeth, I must reiterate, came from natives of an
area where the so-called ideal fluoride concentration is naturally pres-
ent in their water. You see cavities of many and varied sizes, some
large enough for a caterpillar to crawl into; you see also teeth which
are crushed and broken off — many filled — and as for mottling, and dis-
coloration, it ranges from a yellowish brown, which resembles nicotine
stains, to a dark mahogany, red brown color.
This is the usual thing for those who cannot afford to buy bottled
spring water.
Mr. Chairman and gentlemen of the committee, I have here a letter
from Dr. L. D. Parnell, Wichita Falls, Tex. He says :
I operate a clinical laboratory where we run a great number of blood tests
for syphilis.
We found that we could not use the city water even after it had been distilled
three times in connection with these tests.
We received an opinion from a technician formerly with the State health
department, advising us that it was probably due to the sodium fluoride in the
city water.
I immediately procured rainwater, and the tests came out perfectly.
FLUORIDATION OF WATER 113
Ml'. Chairnuui and geiitlemeii of the coininittee :
1. In my animal experiments Avith fluoridation of drinkino; water at
the College of Physicians and Sur<ieons we found marked pathology
in the internal organs of the animals. There were hardening of blood
vessels, canc'er-ex])erimental aninuils developed cancer growth more
rapidl}' and blood clotting time was prolonged.
2. Human experiments with fluoridated water at Brantford,
Ontario, after a few years, shows twice as much dental decay as at the
beginning of the experiment. The United States Bureau of Vital
Statistics shows: in Grand Eapids, Mich., after 4 years of fluorida-
tion there was almost 100 percent increase in death from heart disease,
50 ])ercent increase in death from kidney disease, and 50 percent in-
crease in death from intracranial disease (brain disease). The poj)u-
lati(m increased only 8 percent.
8. In fluoridation experiments at Xewburgh, N. Y., premature
births showed 8 times as much fluoride in the placentas as in adjacent
areas which have not fluoridation.
4. There are a large number of premature births in the Southwest
areas (which have natural fluorine), as for example, in New Mexico,
per 100,000 population there are 55.9 premature births as compared
with the entire New England area which has only 2.4, and has no
natural fluoride in the water (this report is from the Bureau of Vital
Statistics, 1948). Drs. H. V. and C. Smith, fluoride in the blood
stream interferes with calcification of unernpted teeth. Tappeiner
sliows cases on record that ingestion of small amounts of fluoride is
fatal to man and other animals. In the 6 months experiment with
lats. fluoride in small amo\nits caused enlargement of thyroid glands.
5. In the Southwest areas most people drink bottled spring water
at the advice of doctors, dentists, and health officers.
Ck About 300 communities have voted against fluoridation. The
following communities have thrown it out after using fluoridation for
from 4 months to 2 vears: Plymouth, Shewano, and Stevens Point,
Wis. : Mount Dora, Fla., and over 300 others.
7. The following organizations have not given unqualified approval
of fluoridation of public Avater supplies: the American Dental Asso-
ciation, the American Medical Association, and the Hartford County
Medical Society. They endorsed fluoridation "in principle only" ("in
principle," means that it may have some value for laboratory experi-
mental work but not in practice, for use in public water supplies).
Congressional Record. March 1952. Dr. Lull, secretary and general
manager of the AMA. testifies under oath that they did not urge nor
i-ecommend that fluoridation be used in any public water supply.
8. Fluoride mixing machines have frequent breakdowns so that
Avhen more than 1 part per million fluoride is delivered there is no
taste nor odor to Avarn us of the error. This has happened at New
Britain, Southbury Training School, Northampton, Mass., and it AA-as
reported in the American City Magazine of NoA'ember 1951 Avhich
describes continual disruption of service due to the corrosiA^e nature
of fluorides.
9. There is no such thing as a "safe" amount of fluoride, due to the
individual's biological variations. Some children sIioaa- clental fluo-
rosis w^ith as little as 2 tenths of 1 part per million of fluoride. The
fluoridation progi'am urges using five times that amount.
114 FLUORIDATION OF WATER
The chemical sodium fluoride cannot be either assimilated or elimi-
nated, but it is stored in the body. Fluoride attacks the kidneys
causing backaches. Fluoride combines with calcium of the bone and
is found as crystals stored in the hollow portion where the bone mar-
row is normally present. The best teeth are found where there is no
fluoride in the water. Dental fluorosis is an external manifestation
of pathological changes in other parts of the body. The so-called
benefits in Southwest areas are not due to the fluoride in water but to
the increased mineral content of the soil. Artificial fluoridation is
not necessary, as practically all foods we eat contain some natural
fluorine which is easily assimilated by the body.
10. Prolonged or repeated ingestion of any drug, in unknown quan-
tities, without proper medical supervision and without due regard to
the physical condition of each individual, is extremely dangerous.
Fluoride, in particular, being a deadly poison, proven by medical and
chemical research, is potentially productive of dire results on the
human body.
At the present stage of the fluoride experimentation, it is proven
that safer and better methods can accomplish such benefits as are
claimed for children's teeth. It is mass medication, human experi-
mentation, enfringement of constitutional rights, and an entering
wedge to socialized medicine.
11. Chlorination and fluoridation can in no way be compared, as
chlorination treats water to make it safe from harmful bacteria, while
fluoridation treats the body, making it mass medication. Boiling
chlorinated water removes the chlorine but boiling fluoridated water
increases the potency of the fluoride chemical.
12. Mass medication is socialized dentistry, forcing dental care upon
each and every human being, whether we have teeth or not, or whether
we need or want dental care or not, we would be compelled to drink
a solution of fluoride, the most powerful, the most dangerous element
known to man, for which there is no known remedy.
13. Fluoridation interferes with home medication.
14. Artificial fluoridation can be accomplished for those who want
it by the addition of tablets or drops, by topical application and by
using bottled fluoridated water which any health department would
be glad to furnish free of charge to homes and schools, for those par-
ents wlio want it for their children.
15. Fluoridation at best might possibly benefit some, not all children
up to age 8. Many of these children would gain no benefits whatso-
ever ; some will suffer harmful effects, while a small minority of these
children would not be affected either way if they enjoy very excellent
nutrition. The only true benefit to be derived from fluoridation is its
antiseptic quality as a mouth wash which can so well be obtained by
rinsing the mouth with any other antiseptic solution. Those over
age 8 would derive no benefit at all.
16. Governor Dewey of New York vetoed fluoridation. The Hast-
ings Law Journal, spring 1952, proves fluoridation to be illegal. It
is a violation of our Federal Constitution, article I and amendments 1
and 14 thereto.
17. Fluoridation deprives us of our personal liberties, and violates
freedom of personal care of one's own body.
FLUORIDATION OF WATER 115
18. To force fluoridation down unwilling throats is not the Ameri-
can way. Every human being and domestic animal would be co-
erced into drinking fluoridated water making a veritable fluoride
storehouse of our bodies.
19. The health and safety code refuses the right to any department
of health to force compulsory dental examination or service.
20. Dental caries (decay) creates no epidemic or emergency of a
contagious or infectious disease, therefore, there is no "clear and pres-
ent danger" at all, and therefore no Public Health police power need
be invoked.
21. Consequently, it must stand that fluoridation of public water is
unconstitutional and is in violation of State laws and the Federal
Constitution.
22. If the State wants to make fluoridated Avater available to chil-
dren, to partially prevent dental caries, fluoridated bottled water can
be placed in the schools and homes of children for those who want it.
The conflict would then be resolved and at a cheaper price moneywise,
as well as from the standpoint of infringement upon individual rights.
23. Scientists, now engaged in this research work, state that it will
require 20 years to a life span before these experiments can give any
meaningful results. Only the uninformed and the misinformed want
fluoridation.
24. For the preservation of good health and the welfare of our
total population do not sanction fluridation of public water supplies.
25. Pass the bill, H. R. 2341.
26. Allow bottled fluoridated water to be made available to those
who want it, thus permitting us all to have freedom of choice.
I have a resolution of the Citizens Committee Against Fluoridation
and the Connecticut Pure Water Association that I would like to
present.
Mr. Heselton. It will be made a part of the record.
(The resolution referred to is as follows :)
Resolution Against Fluoridation of Public Water Supplies
Whereas fluoridation of public water supplies is in contravention of con-
stitutional rights; and
Whereas fluoridation is a potential danger from sabotage or defective equli)-
ment ; and
Whereas fluoridation coerces mass medication on entire populations ; and
Whereas fluoridation is proven to be a cumulative poison, destructive to body
enzymes, and a protoplasmic poison ; and
Whereas individual biological variation precludes possibility of a "safe"
amount of fluoride ; and
Whereas science does not yet have a sufficiently delicate analytical technique
to detect with certainty what is called subclinical injury ; and
Whereas fluoridation is not necessary for healthy tooth formation and has
never been proven necessary to maintain proper functioning of any body tissue ;
and
Whereas various bureaus endorse fluoridation but do not guarantee (assume
responsibility for) its safety; and
Whereas fluoridation may jeopardize the health of the nation ; and
Whereas fluoridation is economically unsound because water consumed for
drinking and cooking constitutes only 1 percent of total amount of water used;
and
Whereas fluoridated bottled water can be made available to individuals by
local health departments, or by capsules, tables, etc. : Therefore be it
116 FLUORIDATION OF WATER
Resolved, That no attempt shall be made to tamper with the public drinking
water other than for the purpose of purification ; and we are unequivocally
opposed to the addition of any fluoride to any public water supply.
Citizens Committee Against Fluoridation,
The Connecticut Pure Water Association,
Lillian Van de Veee, President.
Mr. Heselton. Your 15 minutes have expired.
Miss Van de Vere. Thank yon, Mr. Chairman.
Mr. Heseltox. On behalf of the committee, I Avant to express our
appreciation of your comina' heie and ]n'esentinir the results of your
extended studies.
The committee has gone 15 minutes beyond the ordinary time for
adjournment and there are other matters that the members of the com-
mittee have to attend to before leaving tonight, so we will adjourn
until 10 o'clock tomorrow morning.
I would suggest this, however, that those who have not spoken,
might well confer together and see if they will not be able to so
arrange their statements that they will be able to stay within the time
available. That is from 10 o'clock in the morning, until 12 o'clock
nooii.
Then, the opponents will start their presentation at 2 o'clock in the
afternoon, if we can obtain permission of the House to sit.
(Miss Van de Vere submitted the following statement for the
record:)
Statement of Miss Van df. Vere
1. Newhuruli and Grand Kajtids Fhnuidation Experiment Stations show sta-
tistics which prove that l)y aue 17 to 18 years, fluoridi^ted water as.uravates dental
decay, so that there is far more dental decay evident in those children who have
used fluoridated water than in the children who have used water without
fluoride.
2. Knowing that fluoride attacks nerve cells (animal experimentation proves
mental retardation among rats which were fed fluoridated water, Representative
A. I>. Miller's report — Consressioiial fliKirldatioi, investigation. Il)n2). is it any
wonder that there is evidence of marked intracranial (means within the brain)
disease among Grand Rapids residents? Fluoride is an insidious poison which
works slowly but surely in its devastating effect and imiiairment of physiologi'-al
processes.
3. The most recent report on dental decay in Science magazine of May 14. 10."»4
(b.v Joseph C. IMuliler and William G. Scbafer), published by the American
Association for Advancement of Science, states, "Decreased thyroid activity is
related to increased caries (dental decay) (susceptibility) in the rat. De.siccated
thyroid reduces the incidence of dental decay to the same degree as sodium fluor-
ide alone." This observation bears out more strongly that dental decay is not
due to a lack or shortage of fluorine in the diet or in the teeth.
4. A communication from Dr. Prothro, imlilic health officer of Grand Rapids.
Mich., in 1952 stated that he is chairman of the heart committee and he is far
more interested in reducing deaths from heart disease than in reducing dental
decay in children, and if there is any scientific information which could be
made available to him. it would be appreciated. In response to this request I
sent a letter to Dr. Prothro. in which I stated the following information — which
may explain why fluoride could be the cause of so many deaths from heart
disease. My reasoning is this : We know that fluoride has a powerful affinity
for calcium, and we know that, because of this, tetany (muscle cramp) in legs
or arms is frequently observed, due to a calcium deficiency. Now transfer this
reasoning of the muscle cramp (which occurs in legs and arms) to a similar
muscle cramp which occurs in the heart (heart is a large muscle) and we have
the reason for increase in deaths from heart disease in areas where water is
artificially fluoridated. Residents from Grand Rapids and other fluoridated
areas told us that their people come home from work, mention that they feel
FLUORIDATION OF WATER 117
very tired, and drop dead, (ientlemen, this is a sitnatimi wliich should no lonixer
be allowed to continue !
."). With all this scientific data aside, ^oin;; on to another asi)oct of the fluori-
dation program. It is the unprecedented behavior of our local public health
(itticials in Hartford, who removed and hid the antitluoridation exhibits from
thet Union Railroad Station (Hartford, Conn.) which had attracted tremendous
crowds of people. The Hartford Health Department exhibited their jn-otluorida-
tion display in the railroad station, bank lobbies, theaters, PTA meetiui^s, public-
health meetings, and the ^lunicipal Buildinjj;. Yet, after permission from the
New Haven Railroad manajjer was granted to show the juitifluoridation exhilnt.
they were removed, without permission, by the Hartford Health Department
otticers. hidden away for days, without notice to anyone connected with anti-
lluoridation, though my name and address were <-learly written on each )iart
of each exhibit. They also removed the antitluoridation exhil)it from our pulilic
lii)rary. When I appealed to our city manager. Carleton Sharpe, he said, "It
is customary for the city manager to stand behind the heads of departments
whom he appoints, and I shall not interfere with the activities of the health
department. Sorry, nothing can be done." He also refused to allow our anti-
tluoridation exhibit in the Municipal Building !obl)y. though he allowed the
profluoridation exhibits for a long time. This was during the period when our
Connecticut Legislature was in session in lOoS. However. I must give full credit
and appreciation to our Governor. John Lodge, who was fair enoiigh to allow
both the pro and the nntitluoridation exhibits tti l)e displayed in our State
Capitol during the period when our legislature was considering some bills on
fluoridation. How is one to interpret such openly antagonistic behavior by
the Hartford Health Department? I tell you this, gentlemen, that you may
know that fluoridation is more than a scientific venture or a medical program.
More recently, our Public Llealth I>entist ;Menczer sent information across
the country that our Hartford City Council favors fluoridation, when the truth
is that Hartford city councilmen voted against fluoridation of iiublic water svip-
plie.s — 6 to 2 (corporation council's letter in committee flies). Then, on Feb-
ruary 10, 1954, this same Public Health Dentist Menczer w.is about to give a talk
on fluoridation of public water supplies to a cluli of young mothers at the putilif
health building. He sent for Police Officer Lee because I and an assistant were
distributing antifluoridation fliers, together with a flier from the United States
Department of Agriculture, which information states that good food makes good
health and good teeth. The complaint against me was that I was distributing
'"offensive literature." We continued to distribute these in the public health
lobby to the club members as they arrived. The public health dentist continued
to berate us and pleaded with the club members to return the fliers to me and
not read them. Needless to say. none were i-eturned, but were placed in their
bags for future reading. The jiolice could find nothing ■■oft'ensive" aliout the
material which we distributed and he told us that the antifluoridationists might
go up to the meeting. OflScer Lee told him that this is a public building, that the
lecture- is public health, and the dentist is a city employee. Dentist Menczer
forbid us to attend. We went to the police building for advice. There was
unanimous opinion among all the detectives and itatrolmen on duty that we can-
not be barred from that meeting. They virged us to attend. When we returned
at about 10 p. m. the building was in darkness and the door locked. Next day
we learned that the meeting was not over until 11 : 80 p. m.. that Dentist Menczer
locked the door and extinguished the hall lights to keep us out.
In March lf)r)4 Jaycees in I'ristol, Conn., planned a closed meeting on fluorida-
tion of public water supplies, to be attended only by the city councilmen, the
water commissioners, and the unit of public health expert.s — (public health
otticer. pul)lic health dentist, public health sanitary engineer (who plans the
technical details for installation of fluoridating machinery) — and public health
profluoridation speakers.
After a tremendous struggle and final intervention in our behalf by a retired
chief justice, whose contention was that every resident who drinks the public
water should have a right to attend such a meeting, to know what is planned
to put into his water supply, and that the invitees should be permitted to hear
both sides of such a controversial subject. The meeting, at the last moment.
was opened to the public, but there was no oppi)sition allowed to be voiced, no
discussion allowed from the floor. The only questions answered were by wiitten
118 FLUORIDATION OF WATER
request, and then only proponents of fluoridation were answered. The Jaycees
had been ash:ed to si^ a request for fluoridation, many months ago, by the
State board of health ; before they had heard anything for or against fluorida-
tion, and they acceded because the board of health asked that they should. So
it was with "the CIO, many PTA"s and other organizations, who have implicit
faith in the health department and would not question their activities.
This whole thing is an exact duplicate of what the Hartford Health Depart-
ment did all last year, when they discontinued open debates and forums on fluo-
ridation. (This was on the advice of United States Public Health Service as
reported in the excerpts of fourth conference public health, dental association,
and child welfare.) Is this the American way? Countless radio programs
carried profluoridation propaganda, but our public health oflicials did not allow
the program directors to permit antifluorido programs. They made many
desi>erate efforts to prevent ray TV panel of Dr. Leo Spira, M. D., Dr. Ginns,
D. M. D., and Dr. Robert H. Mick, D. M. D., all practicing doctors, and myself,
from going on WNHC-TV (New Haven). However, this TV program director
stood his ground because he had given the profluoridation public health officials
twice as much time about a year before, and opponents of fluoridation had been
requesting, by petitions and individually, for free equal time. Now we are
having a repetition of this situation on another network. Why is the public
health afraid to let the public hear or read anything against fluoridation? Are
they engaged in thought control as well?
6. Tliese ai-e statement of facts. I respectfully submit this information that
you may know something of the background which accompanies this forceful
effort of the public health to fluoridate our public water supplies.
7. A little over a year ago I had a very violent allergic reaction from drinking
two cupfuUs of coffee in a fluoriated area. Immediately upon finishing the second
cupful, which was about 15 or 20 minutes after the first cupful of black coffee,
I got violent cramps, felt nauseated, suffered excruciating pain. The room be-
gan to spin around, so that I clutched the table where I had been drinking coffee.
My eyes immediately swelled shut, also my lips. My tongue became swollen
and looked like a golf ball. I could not speak for hours. My face became yellow
and swollen to three times its usual size, then large blisters, the size and shape
of big peanuts appeared on the lower part of my face. After about 2 days, these
blisters broke and there was a violent gush of clear fluid. It happened suddenly
and with such force that it took all the skin off my face and throat. I was left
with bare red flesh, pouring large quantities of clear fluid. The burning, itching,
tingling sensation was more than a human being could bear. I was in extreme
agony, night and day, unable to sleep, with pins and needles sensation along the
underside of my forearms from elbow to and including the little finger and ring
finger and constant, terrific headache. The M. D. who attended me had never
seen such a case before, and declared that it looked like a violent arsenic poison-
ing. After about 7 weeks of struggling with this bafiling illness, I went to an
allergist. He, too, was unable to make a diagnosis at that time. He tried
everything until he found a way to help me and skin began to grow on my face
and throat. During this entire siege I had become allergic to many things, in-
cluding tobacco smoke (I don't smoke). During this time and even now, about
18 months since the fluoride poisoning, my hair has been falling out by the hand-
ful. The definite diagnosis has now been made. Others have had similar ex-
periences. I do not know whether, on that day, the fluoride mixing machine
went out of control (this happened often), or whether the coffee had been
simmering for a long time, thereby increasing the concentration of fluoride.
Should anything so hazardous as fluoride be allowed as an addition to any
public water supply?
During our brief visit to Washington, D. C, some of us used pure spring water
from a local bottling company and avoided any food which was cooked in water.
Those of my colleagues who tossed caution to the wind suffered terrific cramps,
diarrhea, and headache. That is the usual reaction of the body to the first in-
gestion of fluoridated water. Then they had to carry a one-half gallon jugful
of the pure spring water with them, as it became necessary to flush and dilute the
poison. Large quantities of milk gave some relief, as it replaced the calcium
which is immediately attacked by the fluoride. Middle-aged and older people
suffer most ; also the chronically ill, as well as the malnourished children and
adults.
FLUORIDATION OF WATER 119
Gentlemen, it is as much a crime to allow fluoridating of public water supplies
as it is to allow a maniac to run loose and discharge firearms. Nobody knows
who is going to get hurt or who may die as a result of it. May I therefore re-
spectfully implore you to pass H. R. 2341 and set us all free from this abomination
which has come to our country?
If your thinking should lead you to believe that passage of this bill, H. R. 2341,
would interfere with States' rights, please, gentlemen, consider, for example,
murder. That is not allowed in any State. Therefore, to prevent murder, or
any other thing which could cause harm to any human body should be considered
in the same light. Passage of this bill would not deprive any individual from the
use of fluoride in any form, but it would prevent dire effects upon others if
forced to accept it.
(Thereupon, at 4: 50 p. m., the committee adjourned to meet at 10
a. m.. the following day, Wednesday, May 26, 1954.)
FLUORIDATION OF WATER
WEDNESDAY, MAY 26, 1954
House of Representatives,
Committee on Interstate and Foreign Commerce,
Washington^ D. C.
The committee met, at 10 a. m.. pursuant to adjournment, in room
1334, New House Office Building. Hon. Charles A. Wolverton (chair-
man) presiding.
The Chairman. The connnittee will please come to order.
STATEMENT OF HON. GEORGE S. LONG. A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF LOUISIANA
The Chairman. I see our colleague, Representative Long, of Louisi-
ana, is present. Is it your desire to be heard, Dr. Long ?
]\Ir. Long. Yes, sir, JNIr. Chairman.
The Chairman. Are you for or against the bill ?
Mr, Long. Against it.
The Chairman. We have been hearing and expected to hear this
moruing, the continuation of the proponents. However, we do make
excei)tions in the case of Members of Congress, because of the fact that
they have other duties to perform in other committees. So we will
hear you, even though we have allotted this time to the proponents.
The clerk will please take due note of the time Mr. Long uses, so that
the pro])onents will likewise be recognized for the same time.
Mr. Long. Thank you very kindl}', Mr. Chairman.
First. I want to thank the committee and the chairman for the
j)ri\i]ege of appearing here this morning. I have a prepared state-
ment tluit I would like to submit for the record, and then to discuss
from that prepared statement briefly, in order to save you as much
time as I can.
The Chairman. You may do so.
Mr. Long. I want to take but a minute of your time this morning
to ex{)ress myself as opposed to H. R. 2341. I have practiced dentistry
for more than half a century. During that time, I have seen many
mouths ravaged by decay, decay which could have been largely pre-
vented had the benefits of our present-day knowledge of how to adjust
the fluorine content of Avater supplies been available to them.
As a dentist, I have been interested in the development of this pre-
centive device. I have studied the scientific articles relating to it and
I am convinced that it is absolutely safe and that it will help to reduce
dental decay.
I suppose you are familiar with the amount of money spent each
year by the Federal Government for dental services to servicemen, to
121
122 FLUORIDATION OF WATER
veterans, and to beneficiaries of the United States Public Health Serv-
ice. Last year it amounted to more than $100 million. As a dentist,
I know that a large part of this expenditure is caused by the tremen-
dous number of cavities found in the mouths of these people.
If all had been able to drink fluoridated water during their early
youth, they would have been saved an immense amount of suffering
and the Federal Government would have been saved a tremendous
amount of money.
I would like to say also that I am opposed to those features of this
bill which would encroach on State and local rights of self-deter-
mination. I don't think that it is the business of the Federal Gov-
ernment in Washington to tell the people of my home city of Pine-
ville. La., whether or not they should drink fluoridated water.
I don't think that the people of Louisiana would like the Federal
Government to tell our State legislature that it cannot pass a law
authorizing community water fluoridation if it deems such a law wise.
And furthermore, I don't think that the Congress has a constitutional
right to take such action.
Consequently, gentlemen, I recommend to you that you defeat this
bill leaving to the several States the right to decide whether or not
fluoridation is good for their people. If you do, I think as a prac-
ticing dentist, that time will show that the benefits of this nutrient
will, in the not-too-distant future, be available to most of the children
who drink water from connnunity supplies, and that the resultant
decrease in the amount of tooth decay will be both a health and an
economic benefit to this country.
I just w^ant to take a few minutes of time this morning to express
my opposition to H. R. 2341.
I have practiced dentistry for more than half a century. During
that time I have seen many mouths, and I have been engaged in much
research work. I have used a great deal of my time as a practicing
dentist in helping in research, to try to find some of the cures for some
of the things that have beset mankind in the way of decay and dis-
eases of the mouth.
I have used up a great deal of time and not only been interested in
watching, but have been interested myself in research, in taking the
actual patient, giving some of them fluorine and not giving it to
others, and it has been my studied opinion that the fluorine has been
very helpful, and I am very much surprised to see that some men who
are learned men would take an opposite view of this splendid work.
I can only say that it has been helpful in my own practice and it has
done much good, and I know of no place where fluorine has injured
any person for having used it in the water.
But, may I make the statement that my opposition to this amend-
ment is from the State rights proposition. I would not like to have
the United States Government come into my little town of Pineville
and say, "You cannot put fluorine in the water," after the chemists,
the doctors, the scientists, have said that it would be good to be used
on our children's teeth in that manner.
I think this is a matter to be settled by the various States and vari-
ous communities, and I do not believe, in my humble opinion, that it
has any business in the Congress of the United States.
FLUORIDATION OF WATER 123
Much time and much money has been spent by our Government on
researcli. Nothing is more crippling and disfiguring than decayed
teeth. Nothing has caused more ill health than trouble with decayed
teeth, in my humble opinion, and that is after 50 years of hard work
and study.
Anything that will help to have better teeth and less decay is of
great value.
You might ask me why the dentists are so interested in this. My
answer back to you would be, if you would multiply the number of
dentists by 10 that are now practicing dentistry and, all of the chil-
dren and all of the people should suddenly have money enough to
have teeth lixed, in the next 10 years you still would not have made a
start on the job, in reducing the amount of decay in existence. And,
it starts with children early in life and they go through their life with-
out having teeth enough to masticate their food properly, and their
life is shortened by a number of 3^ears and their happiness is short-
ened a gi'eat deal.
We will be a happier people whenever we reach that point that
we can listen to the scientific people and the people who are working
with chemistry, in the interest of the human race, and we will be
better off when we have more faith in them, and place our faith in
the men who are handling the dental proposition and the other propo-
sitions that we have to contend with, so far as medicine is concerned.
1 thank you for this opportunity, Mr. Chairman.
The Chairmax. Are there any questions ?
Dr. Long, we appreciate your appearance today and the statement
that you have made, which is based upon your long experience in the
practice of dentistry.
Dr. Long. That is right.
The Chairman. I can assure you that the testimony that you have
given will have the very careful consideration of the members of
this committee.
Dr. Long. Thank you, sir.
The Chairman. And, your statement will be made a part of the
record.
Dr. Long. Thank you, Mr. Chairman.
The Chairman. Dr. Long consumed 5 minutes. Is Senator Hunt
present ?
The Clerk. He is on his way.
The Chairman. I have statements for the record from Lt. Col.
Robert J. II. Mick, of the United States Army Medical Corps, now
serving in Germany. Colonel Mick is a resident of the congressional
district which I represent. His home is at Laurel Springs, N. J.
You can readily understand that the statement which has been sub-
mitted by Colonel Mick is not in any way to be considered as a state-
ment of the viewpoint of the Army Medical Corps. It is solely and
entirely his individual thought.
He had hoped that he would be present. I had assured him he
■would be given an opportunity to testify when these hearings were
held. That was prior to his entrance into the Army.
Recently, when he entered the Army he was sent to Germany. He
had hoped to be able to get permission to return in order to testify,
48391—54 9
124 FLUORIDATION OF WATER
but as that has not been possible, he has sent to us his prepared
statement.
He has requested that it be made a part of the record and, I will
see that it is made a part of the record.
In addition to that, he also sent a tape recording of his views, which,
would take approximately 45 minutes, if that were given. Of course,
there is not time for that. His entire statement will be made a part
of the record.
(Someone from the audience asked if he was for or against the bill.)'
The Chairman. He is in favor of the bill, and very strongly in
favor of it.
It would have been very helpful to have had the benefit of the testi-
mony of Dr. Mick, because I know of my own personal knowledge,
that for a long period of time he has worked as zealously in his study
of this particular problem. His convictions, which are very strong,
have risen as a result of that long and careful study, and experimenta-
tion with rats and mice and whatnot.
(The matter submitted by Dr. Mick is as follows :)
P^'iFTH General Hospital,
Bad Cmrnstatt, Oermany,
A. P. O. 15.',, Netv York, N. T.
Hon. Charles E. Wolverton,
Chairman, Committee on Interstate and Foreign Commerce on Subject of
Fluoridation of Water, 3136 House Ofjficc Building, Washington, D. C.
Dear Mb. Wolverton : I trust that above committee hearing testimonies of
fluoridation of water will allocate sufficient time to listen to part II of my tape
recordings. This part of tape deals with the mechanical relationship of quality
of teeth to waters. Sufficient copies of mimeographed ••following" slieets should
be available to committee.
Part III of tape covers many of the reported harms on animals and animal
experimentation from jii-esence of fluorine.
Part I of tape covers part of the story on how certain groups or representatives
of such groups have used their influence to keep the public and professional men
misinformed, including letters to me. Such groups include New .lersey and
Kansas Public Health Service, New .lersey State Dental Society, and the Surgeon
General's Office of the United States (Department of the Army) and the United
States Public Health Service.
Attached hereto are evidence against the use of fluorine, including photo-
graphs with explanations of experimental animals. This will disprove the
value of artificial fluoridation of water and will also show the long-tei-m harmful
effects of same. This series is sheet No. 1. (Filed with committee.)
Sheet No. 2 contains photographs and explanations of fallacies (1) of protec-
tion from dental decay in area, today, where fluorine is naturally in the drinking
water; and (2) of the lack of need of any fluorine at all in drinking water, as
showii by the United States Public Health Service. This latter part is also
covered in tape II. (Filed with committee.)
Yours sincerely,
Robert J. H. Mick
Dr. Robert J. H. Mick,
{Lieutenant Colonel, USAR DC) D. D. S., Laurel Springs, N. J.
P. S. Have enclo.^ed hectographed copy of tape II with complete set of fol-
lowing mimeographs.
Wording of Tape No. 2 of Dr. Robert J. H. Mick, Laurel Springs, N. J.
My name is Doctor Rol)ert J. H. Mick, of Laurel Springs. N. .1. Inasmuch as
I am now a lieutenant-colonel in the United States Army the opinions and as-
sertions here are mine and not to be construed as that of the Army or the
armed service at large. Tliis presentation begins with the date that the town
without a toothache received its national and international publicity and of
how the original misinterpretations of statistics originated two fallacious-
FLUORIDATIOX OF WATER 125
stories: first, that of a direct relationship of l)etter teeth being found in some
areas havint;- tluorine in the driiikiiiii' water, and second, the presence of llnorine
in the drinking water of some areas being responsible for tooth decay in an
inverse relationship to the percentage of parts per million of Huoriue found.
But let us go back and see how the story of fluorine really got started. We'll
take from the February issue of 1948 of the Reader's Digest, the story of the
town without a toothache, of which many of you may be familiar — 1 will read
in part l)ecause it is so important :
Thk Town Without a Toothache
.T. D. Ratcliff
(Condensed from Collier's, December 19, 1952)
A hopeful approach toward finding the cause and cure of the most prevalent
of all human ailments — dental decay — has been made by shy little Dr. George
W. Heard of Hereford, I>eaf Smith County, Tex. Xow 75 years old. Dr. Heard
moved to Texas from Ahibuma 2(> years ago and started to practice dentistry
tliere.
Almost from the start he noticed that tliere was virtually no tooth decay
among old residents. New settlers miglit need an occasional iilling. Gum and
bone infections would sometimes necessitate an extraction or platework. But
there were none of the fillings that make up the bulk of the average dentist's
work.
This absence of decay puzzled Dr. Heard. He questioned old-timers. "Never
thought about it," they said. Funny thing, though, they added, you c(>uld
bring spindly lishbone cattle up from Mexico, graze tliem for awliile, and they'd
turn into fine )>ig-boned animals. And horses in the county had tine teeth.
Even one old dog around town, IG years old, still had all his teeth.
For years Dr. Heard went along looking for decay — and hardly ever finding
it. For years at dental meetings he tried to Interest somebody in tliis strange
business. I-'inally he buttonholed Dr. Edward Taylor, able, hard-driving State
dental officer. Taylor drove througli the county, picked houses at ramlom,
introduced himself, and asked if he could examine the family's teeth. Among
5H ])eoi)ie, of whom 4;> were native born, varying in age from 2 to past 60, Dr.
Taylor couldn't find a single cavity.
Sul)sequently an examination of SIO Hereford school children revealed that
well over half had no decay whatsoever. Eacli child was graded on a basis
of decayed, missing, or filled teeth — DMP — in dental parlance. Average figures
showed one DMF per child. Elsewhere it would hiive been from 5 to 10 per
child.
Another striking fact turned up. In people w'ho had moved to Deaf Smith
County in the last lialf-dozen years, evidence of old decays were foiuid but
the process had stopped. In many cases the floors of old cavities had acquired
a liard, glazed surface.
To determine the cau.se of tliis fantastic low rate of decay, peculiar to a small
region in and around Hereford, research men first investigated the drinking
water, which proved to contain 2.5 parts of fluorides per million parts of water.
But fluorine alone wasn't the answer. In another Texas town with exactly
the same concentration of fluorides, the decay rate, though low, was more than
twice the rate at Hereford.
Fieldmen gathered samples of meat, mill^, wheat and vegetables, for analysis
at Texas Technological ( 'ollege. Almost from the outset one fact stood out
clearly: the foods were astonishingly high in phosphorous, probably the most
vital of all soil minerals. Carrots contained 50 percent more than usual, turnip
greens ."SO percent, cabbage and lettuce GO jtercent. Meat and milk were simi-
larly high in phosphorous. Wheat, the chief focxl product, ran GOO percent above
normal. Calcium content also was high.
Foods grown in Deaf Smith County probably obtain their superabundance of
phosiihorous from the soft, porus caliche rock which underlies the area. Roots
dip down into this spongy roclv for minerjil nourishment.
Whether phosphorous alone is responsible, no one yet is preiiared to sa.y.
Research men elsewhere have noted that rats fed liigli phos]ihorous diet have
unusually good teeth. Fish is one of the richest sources of i)hosphorous, and
anthropologists have found that decay is rare among primitive, fish-eating peo-
126 FLUORIDATION OF WATER
pie. Over large areas of the earth, bad farming has mined out this vital min-
eral. Cattle grazed on such land fail to mature properly, human beings become
sterile. It seems possible that tooth decay is merely tlie first outcropping of
phosphorous deficiency.
Dr. Taylor is inclined to ascribe the low rate in Deaf Smith County to fluorides,
sunshine, and calcium, as well as to phosphorous. Evaluating the part each plays
is a job of considerable proportions — a job for a trained research grovip, armed
with money and talent. Forward-thinking dentists realize their inability to
cope with the problem of decay. Most people haven't enough money to buy
proper dental care, and if they had there wouldn't be enough dentists to supply
it. What is needed is more fundamental work on the causes; and this research
in Deaf Smith County has opened the door for it.
The original investigators never said that fluorine was the cause of better
than normal teeth. But it was Dr. Taylor, Dr. Ast, Dr. McKay and all the other
sponsors who started the fluorine story and who have since tried to save face,
that have perpetrated this story. Let me continue. This original story was the
story of Dr. George Heard, back in 1941. But let me read to you a little note of
March 11, 1954, in which he says, "this fluorine craze is not correct. I am sure
if another survey is made of Hereford the findings would be very different be-
cause the food there is different. The pictures in my book reveal this fact.
There are families of children here who have no caries and there are families
here who have plenty of caries. There are families here where the children are
different. Some have caries and some none. The difference is in the food in-
take. The mouth reveals the type of food consumed." The sponsors of fluori-
dation would have you believe there is au inverse relationship between the
amount of fluorine in the water and the amount of dental decay that is present
in the mouth, and they continue with such misinformation, publishing it in aU
the newspapers and articles, such as in the Kansas City Star, Thursday, Decem-
ber 31, 1953 and also again in the Kansas City Star Monday, January 11, 1954.
Incidentally, Kansas City studied the story of fluorine for over 5 years. They
turned it down in December of 1953. Let us assume that 1 or 11/2 parts per million
of fluorine added to water as the sponsors have told you, or recommended, will
stop dental decay or will give better teeth, then, will the sponsors lead you to
believe that you can add just this recommended amount to distilled water, and
your children drink this type of water and have the beautiful teeth that you
expect? Will they guarantee there will be less dental decay, or will the same
sponsors lead you to believe that you can drink the cola drinks or soft drinks
and having used a city water, of 11/2 parts per million of fluorine mixed with it
and that your children will develop good teeth and that they will not develop
dental decay. Or, could there be some other factors in these waters as in
Hereford, Tex. ? You remember it has the same amount of fluorine in the water
as the town 50 miles away but the town 50 miles away had twice as many cavi-
ties. This is not the only place where this phenomenon has taken place, and I
will come to it. Or sh-all we go back to Amarillo, Tex., which is a neighbor to
Hereford, Tex. and take their water and take the fluorine out. as is now being
done by families that can afford it. They buy machinery and a little equipment
that tliey put in the kitchen to remove the fluorine from the water. It is recom-
mended for such by the physicians, or if you could still further afford it, in
Amarillo, Tex., you buy Luzarken water which is advertised free from fluorine."
Or should your children drink water as on the American Islands of Samoa to
get their beautiful teeth, where the United States Public Health Service did beau-
tiful work in 1950, where no fluorine at all was found in the water. Have you
been told that?
Colorado Springs is often used as an example of why fluorine is good, they
have approximately 2.6 parts per million of fluorine in their water but you are
not told that there is almost 100 percent of mottled enamel either to one extent
or to some one degree or another. But Woodstown, N. J., has approximately the
same amount of fluorine in their water (2.6 parts per million) but they have
practically no signs of fluorosis at all. And there is Faulkland, S. Dak. They
have approximately 2.8 to 2.9 parts per million of fluorine in the water which
should give the children all mottled enamel, but there is practically no mottled
enamel at all, why? Because of something that these men are not telling you
that is also found' in the water. Or have you been told about Kiowana, Kenya,
where the natives and the Indians (the Indians are from India) drink exactly
the same water containing the same amount of fluorine in it. The only thing
that they have in common is the drinking water. The natives have appruxi-
FLUORIDATION OF WATER 127
mately the same amount of mottled enamel as the Indians but the natives have
approximately 1 percent of their teeth that have any signs at all of minute decay
and the Indians have (i percent, which is GOO percent more. Or, another way of
saying it, 10 percent of the natives may have some dental trouble but 40 percent
of' the Indians have decayed, missing, or tilled teeth. That is a difference of
400 percent. There are every type of dental defect amongst these Indians that
you could find. LUit amongst the natives there wasn't even an interproximal
cavity. If Huorine was the miracle mineral both the natives and the Indians
drinking of the same type of fluorinated water would have had the same pro-
tection. Is that not right? But then let us go back and try to find out what is
the relationship between water, not fluorine, to good teeth or to bad teeth and
let us start with the statistics -that were published under the title of "Domestic
Water and Dental Caries," April 11, 1941, by the United States Public Health
Service. The investigators here were Doctors H. Trendley, Dean, Phillips, Jay,
Arnold, and Elvove. This story is on the various cities in Illinois, with which
you may be familiar. They are Elmhurst, Maywood, Aurora, Joliet, Elgin,
Evanston, Oak Park, and Waukegan, and you are shown that as there is no
fluorine in the water of Waukegan, Oak Park, and Evanston, and that 97% per-
cent, V6 pei-cent, and V,6 percent of the individuals examined had decayed, missing,
or filled teeth. And where there was 0.4 part per million of fluorine in the water
only 8S percent had decayed, missing, or filled teeth, and where there was 1.2
parts per million of fluorine it dropped to 81% percent to 7.5 percent and where
the fluorine increased to 1.4 parts per million in the water then only 73i/^ percent
had decayed, missing, or filled teeth and at Elmhurst, 111., where 1.8 parts per
million fluorine was in the water 73 percent of the individuals had decayed,
missing, or filled teeth. Or you can say it in another way.
That at Elmhurst, 111., where there is 1.8 parts per million of fluorine in
the water that 112 out of 154 examined had .some trouble with their teeth and as
the fluorine content completely disappeared down to Waukegan that out of 229
examined 223 had decayed, missing, and filled teeth. Or even to make it sound
worse, that at Elmhurst, where there was so much fluorine in the water, that
there wei"e only 3S1 with decayed, missing and filled teeth altogether out of all
those examined, while at Waukegan the decayed, missing, and filled teeth
increased to almost 1.900. On the surface these statistics are absolutely correct
but what they didn't tell you is, that as the amount of total solids increased
in the drinking water that the amount of dental decay also decreased. Now
refer back to these towns and look imder the total solids present in the water
at AVaukegan. There were 155 parts per million total solids (and total solids
are all the minerals that are found in your water) though there was no part
per million of fluorine and the total solids increased in Elgin to 180 parts per
million to .Toliet to 5()(i parts per million, to Aurora and Maywood close to 730
parts per million and in Elmhurst 737 parts per million of total solids in their
water. Now .iust what are total solids'? Total solids are the combination of
all the solids that are found in yoiir drinking water upon analysis. Let us take
for example Laurel Springs, N. J., where the total solids part per million are
100. There, if you took 2 gallons of water and boiled it down you would have
a residue of a grayish, yellow matei-ial. These are the salts riiat are in the
drinking water. These would weight approximately 18 grains. Now let us go
to Woodstown, N. J., where there is 2.6 parts per million of tiuniine in the water.
There you will find 485 iiarts per million of total solids. If you boiled 2 gallons
of this water down you will get also a grayish, yellow mass a little bit different
than that found in Laurel Springs, but you will have 63 grains of these minerals
compared to the 18 grains found in Laurel Springs water. Now what does that
mean? That means that every time that a child in Woodstown, N. J., takes a
glass of water they get approximately four times more minerals per glass of
water than a child drinking Laurel Springs' water. Or, say it another way, the
children of Laurel Springs would have to get or would have to drink 4 glasses
of water to get the same quantity of minerals as those in Woodstown, N. J.,
and we haven't discussed quality.
Let us assume that you have a form to fill with concrete, concrete being
a mixture of water, sand, cement and the other necessary elements. After
you've made your mixture you find that you only have half enough cement mixed
up. All you have to do is to add sufticient water to double the amount of cement,
mix it up and pour it in that form. Eventually it will form a solid mass, but
the original minerals will not have been increased and the total strength of
the structure will not have been increased either. That is the same way with
getting more minerals or less minerals. If your children can get more minerals
per glass of water or in their food they have a better chance of having better
128 FLUORIDATION OF WATER
boiips and better teeth. Let lis look at it in a different way on the relationship
of this fluorine to possible making of better teeth or the prevention of dental
decay. If yon are going to bnild a house you have timbers or structures and they
have to be a certain length and certain size. You can build them out (f oak or
you can build them out of balsam, and they will both be the same size and length
but you will not have same strength, the oak being the stronger of the two and
the more dense. Now let us assume that you are building them out of oak and
that is tine. Along comes the termites and they start to put holes in the oak
structure. Now you call in the exterminators. They come in and destroy
either the termites or they make the wood so that the termites will not come in
it. You still have the holes in the wood, but the strength is not increased. That
is the same story with fluorine added to water. You can put in a substance
that may be able to stop dental decay, but you do not increase the strength
and you do not increase the quality of the original structure. Let us go back to
the towns of Illinois. The children in Waukegan in their glass of water drink
155 parts of total solids per million while those in Elmhnrst consume 7;'>7 parts
of total solids per million. The children in Elmhnrst only have to drink 1 glass
in 5 theoretically, to get the same number of minerals as those in Waukegan,
or reverse it. The children of Waukegan have to consume 5 glasses of water
to Elmhurst's 1 to get the essential minerals or total solids that make for good
bodies and good teeth. If you had a garden or farm and wanted good vegetables
you wouldn't put fluorine in the land, you would go out and get minerals —
minerals — those essential things that make for better growth stt that the animals
or human beings eating of the vegetables grown on the soil that is high in
minerals will in turn have better nutrition. Some of you may still believe that
if my story of total solids was correct the United States Public Health Sei"vic<>
would surely come and find out if it were true. But, let me tell you, that is not so.
The United States Public Health Service did commendable research work in
1950 which shows that fluorine is not required at all in the drinking water of
anyone to have good teeth and here it is. These are the results of the 1!)50 survey
of the American islands of Samoa, conducted by the United States I'ublic Health
Service and presented by Dr. Losee at the 1952 convention of the American
Academy of Nutrition and released with the permission of Dr. H. Trendley
Dean. Of the 6 islands of the American islands of Samoa the decayed, missing,
and filled teeth in 100 vary from 10 in 1 group to 167 in another and those indi-
viduals having decayed, missing, and filled teeth vary from 6 in the first group
to 49 in the sixth group, and when the water was analyzed there was no
fluorine at all. There was no fluorine at all found in 5 sources of water and in
the sixth there was 0.2 p. p. m. The conclusions of the United States Public
Health Service are: That the teeth get worse as the calcium gets less, as the
magnesium gets less, as the chloride gets less, and the total solids get less, as
the residue gets less, as the silica gets less, as the dicarbonates get less, and
nothing is said about fluorine at all in the relationship to good and the bad
teeth. When the sponsors of fluoridation talk about the amount of fluorine in
water, make sure whether they are talking about the deep-well tests or whether
they are talking about surface water. Because, as in Colorado Springs, water
comes from the snow from the high mountains and runs over fluorine-bearing
ore, such as bauxite and cryolite, and it will take up a large amount of fluorine.
But in all deep wells where fluorine has been found and where the statistics
have been gathered, you can find only a certain amount of fluorine, at the most,
in proportion to the total solids or the minerals that are present. You can find
water that is fairly high in total solids with no fluorine at all but you can nevei
find water that contains fluorine that isn't in a proportionate relationship to
the total solids or minerals that ai-e present in the water. The sponsors of
fluoridation lead you to believe that urine can be used as a control for toxicity
or accuiHulation of fluorine in the body.
But let ns refer again to the figures gathered by the United States Public
Health Service on the American islands of Samoa. Here the United States
Public Health Service also analyzed the urine of the males and the females for
the fluorine content. Upon analysis the males contained from 1.4 parts per
million of fluorine in their urine to approximately 0.36. The females ran from
0.4 to 1.58 parts per million of fluorine in their urine. Where did this fluorine
come from? They started with no fluorine in the water. It could have come
from no other place of course, than the food. So, let ns go to Philadelphia.
Here also the water contains 0.0 to 0.2 parts per million of fluoilne in the water.
A man working in Philadelphia and living in Philadelphia, upon analysis, has
1.2 parts per million parts of fluorine in his urine. Where did that came from?
Let us go to Woodstown, N. J. Remember, now, we are talking about natural
FLUORIDATION OF WATER 129
fluorine in water. Here 1 male specimen excreted 2.3 to 2.6 parts per million
fluorine. The second male excreted 2.9 parts per million of fluorine in his urine.
No. 1 female excreted 1.2 parts per million and the second female excreted 1.8
parts per million of fluorine in her urine. What happened to the fluorine she
started with? She started with 2.0 parts per nuUion of fluorine in her urine.
All of these individuals lived in Woodstown under normal conditions. If there
can be no control of fluorine found naturally in drinking water how can there
be any control for artiflcally controlled Huorine? Do the bones have an affinity
for fluorine? Well let me quote you. In an article in the Journal of the Ameri-
can Water Works Association, in August lfl.")3, entitled "Tlio Fluoridation of
Municipal Water Supplies" it is stated "that it has long been known that bone
has an aflinity for fluoride and that the use of bone was one of the earliest
methods suggested for defluoridating water." Do you realize that there have
been five plants in the United States today that have attempted to take fluorine
out of the water? Also stated in this same article in the Journal of American
Water Works Association, "That any water containing over li/j parts per million
of fluorine is considered containing excessive fluoride." The people of Junc-
tion City. Kans., were told that the fluorine content of their water was to be
raised to one part per million. But at one time they were drinking 1.4 parts per
million without their knowledge. In an article in that same Journal of the
xVmerican Water Works Association entitled "The Affects of Fluoride in North
Dakota Water Supplies" by Williams, they concluded that the rate of protective
values can be determined for any group using the common water supply, but
there will be a lessening of the rate of protection above the ages of 10 to 13, the
age increasing with increasing fluoride content. Now we're talking about natural
fluorides. They also concluded that some factor or other than the presence of
fluoride retards decay between the ages of 8 and 11. This is on page 878 in the
August edition. And they conclude finally : "that further investigation should
be taken to answer the questions posed by (Officer Bacon in the present survey :
First, why does the rate of protection change above a certain age (now we are
talking about natural fluorides) and, second, what is the apparent antidecay
factor operating between the ages of 8 and 11? The original investigators have
bypassed the work that was done and sponsored by the American Dental Associa-
tion back in 1924-26 and published in the 1926 edition of the Journal of the
American Dental Association. This work was done under a grant from the re-
search commission and it is the only work that has even been sponsored and
paid for by the American Dental Association. This work was done at the
West Texas State Teacher's College under the leadership of Dr. Pierle of Can-
yon. Tex., and this is the only conclusion that was ever published in a dental
magazine on work that was paid for by the American Dental Association. There
are three conclusions : First, that it is possible to produce mottling and brown
stain in the teeth of animals by lowering the calcium intake below that needed
for the gi-owing animal ; second, it was also possible to prevent mottling by sup-
plying the calcium requirement of the animal ; and, third, the production of good
teeth must begin during the gestation period by feeding the mother with sufficient
bone- and tooth-forming material to meet all requirements. Folks should know
that any city that has a water-softening plant is stealing vital minerals from
fbeir children, such as the minerals of calcium and magnesium and the body
building bicarbonates which are required for strong teeth and strong bones.
They are the minerals that are removed so that the people can have soft water
at the expense of good teeth. What are these requirements? The name of Dr.
Harold F. Hawkins is familiar to all dentists. He states, "the tooth is com-
posed essentially of lime salts. The enamel is the most important tooth structure
in consideration of caries, for if there is no gum recession, the enamel has to be
penetrated before the dentine can become involved. The enamel is composed of
almost 90 percent tricalcium phosphate and about 10 percent calcium carbonate
with traces of magnesium, fluorine, and so forth.
Tape No. 2. Mechanics of Water in Relvtionship to Quality of Teeth (or
Decay Resistance) and Dental Fluorosis
Dr. Robert J. H. Mick. Laurel Springs, N. J.
(This supplements listening to tape No. 2)
Concernintr Hereford. Tex. (See accompanying article "Town Without a
Toothache," Readei-'s Digest, February 1943) : It is due to this partial reprint
and in turn partial quotes of same, that public was first misinformed (para-
130 FLUORIDATION OF WATER
graph of Dr. E. Taylor's. Public Health official) on relationship and importance
of fluorine to quality of teeth and dental decay.
Reference : Fluorine content Hereford, Tex., drinliing water :
2.5 parts per million.
Dental conditions : Reported by Dr. George Heard ;
Dental decay progressively worse on same fluorine water.
1916 (approximately) — Number of cavities among native residence: approxi-
mately nil.
Dental decay progressively worse on same fluorine water.
1942 — Out of 810 children examined, over one-half had no decay at all.
1954 — (March 11) (Letter to Dr. Mick from Dr. George Heard).
(Increase over 1942).
Dental decay progressively worse on same fluorine water.
Same report : Families with no cavities ;
Families with plenty of cavities.
1942 — Town, with same fluorine content (2.5 p. p. m.), had over twice as much
dental decay.
Reference : Which liquid containing fluorine contributes most for better teeth
and bodies, less tooth and body disease?
1. Distilled water (mineral free) plus 1 p. p. m. fluorine.
2. Sweetened beverages (Cola, etc.) plus 1 p. p. m. fluorine.
3. Natural waters normally containing 1 p. p. m. fluorine that produces no dis-
coloration of teeth.
(a) Natural waters normally containing 1 p. p. m. fluorine, which causes
varied degrees of permanent discoloration of teeth (Arizona), or dilution.
(b) Natural waters normally containing 1 p. p. m. fluorine; but, as re-
ported by Kemp, Wilson & Roberts in their investigations. 64 percent of a
group of children (ages 14-17) exhibited ostedchondritis of the spine
(Launton, England ; 1 p. p. m. fluorine).
(c) Natural waters with 1 p. p. m. fluorine added artificially.
4. Natural waters with higher than recommended fluorine content, the re-
moval of which fluorine is suggested by physicians to prevent permanently dis-
colored teeth (as in Amarillo, Tex.) :
(fl) Natural waters with high fluorine content where "fluorine free" water
is imported to prevent permanently discolored teeth (as in Amarillo, Tex.).
(ft) Natural waters with higher than that recommended, causing only
disfiguring mottling of teeth of children ; but in report of Shortt conclusive
evidence is presented that the fluorides are responsible for a high percentage
of crippling skeletal manifestations in adults over 30 years old.
5. Waters naturally containing less fluorine than recommended, but capable
of causing permanently discolored teeth (Tucson and Chandler, Ariz.).
6. Waters naturally containing 50 to 150 or more fluorine than recommended ;
but cause no discolored teeth, as in Faulkton, S. Dak., and Arizona.
7. Waters containing approximately 2.6 parts per million fluorine (as Colorado
Springs, Colo.) that causes almost 100 percent permanently discolored teeth
with higher decay rate after 18 years of age (AWW Journal, August 1954).
8. Waters containing approximately 2.6 parts per million (as in Woodstown,
N. J.) with no gross fluorosis (compared to Colorado Springs) with consistent
decay-resistant teeth after 18 years of age.
9. Waters containing approximately same fluorine in 2 different towns, 50
miles apart, but where dental decay rate of 1 town is over 100 percent greater
than other (as reported in Collier's, December 1942). (Same fluorine content;
varied dental decay.)
10. Waters of a town (Kisumu, Kenya) containing fluorine where different
groups drinking same water have a difference of 600 percent in number of
diseased teeth; and there is a difference of 400 percent in number of children
having diseased teeth, although each group had approximately same percentage
of discolored teeth. (Same fluorine content; varied dental decay.)
11. Waters of a section (around Ilbissel, Kenya) where all ages of children
have 100 percent perfect teeth and no discoloration.
12. Waters containing higher than recommended amount of fluorine, but on
varied human food programs can produce both discolored teeth or nondiscolored
teeth (as reported ADA Journal, July 1926).
13. Water containing lower than recommended amount of fluorine, but on
varied human food programs can produce either opaque, poor-quality teeth,
or transparent, high-quality teeth (Mick, 1949-53).
FLUORIDATION OF WATER
131
14. Water (same as above) containing lower than recommended amount of
fluorine, plus the conditions known to produce fine-ciuality teeth, but witli
addition of artificial lluoride to this water produces iwor, hollow, blunted
teeth, poor bones, a crippled, emaciation, paralysis, and accumulation of up to
500 percent more fluorine in the teeth, bones, livers, kidneys, spleens, than in
same type animals drinking same type of water without the artilicial addition
of fluorine. (Mick.)
1."). Waters (reported by U. S. Public Plealth Service in 1950 in survey of
American Islands of Samoa) known to be fluorine-free, which help produce
beautiful decay-resistant teetli.
l(i. Waters containing naturally less fluorine than recommended ; a report
by Pandit et al., covering 3 years of investigation in areas with fluoride content
as low as 0.6 part per million, disclosed symptoms of chronic crippling intoxi-
cation in residents of over 15 years.
17. Or is it waters that have been artificially fluorinated for centuries that
have produced decay-free teeth in flsh and animals ; or if children drink the
same water as a dog, yet the children develop decayed teeth, and the dog
doesn't, can fluorine, added to the water, improve either the dog's teeth or
the child's health'? (Dental disease is merely the visual appearance of possible
accompanying internal disease or degeneration.)
15. Or (back to reference No. 1 on Hereford, Tex.) should more fluorine be
added to water known to produce perfect teeth three generations ago, although
in 1954 (according to the same Dr. George Heard w'ho reported those decay-
free teeth) some of the children living in the same area, drinking of the same
water, have many decayed teeth?
Reference: Rclationshii) of presence of fluorine to dental decay — "Domestic
Water and Dental Caries"— VSPHS
[Figures by H. Trendley Dean, Arnold, and Elvove, Apr. 11 1941]
In Dlinois
Parts per
million
total solids
Parts per
million
fluorine
Dental ex-
perience
rate perma-
nent teeth
decayed
per 100
children
Number
examined
Number
having
decayed,
missing,
filled teeth
Number of
decayed,
missing,
filled teeth
Percent of
deciiyed,
missing,
filled teeth
Elmhurst ..
1.8
1.4
1.2
1.2
.4
0
0
0
■ 252
2.58
281
323
444
673
722
810
154
139
340
233
250
208
208
229
112
100
255
191
223
200
202
223
387
352
957
785
1,113
1,399
1,508
1,891
73.0
Mavwood
73.5
Aurora
75.0
Joliet-
81.5
Elgin
89.0
Ev;inston
96.0
Oak Park.-
96.0
97.5
Reference: Total solids of Laurel Springs and Woodstoicn, X. J.
ivater)
(2 gallons of
LAUREL SPRINGS
WOODSTOWN
Total solids: 100 parts per million (ap-
proximately 18 grains).
Fluorine : 0.05 part per million.
Fluorine to total solids : 1 to 2,000.
Color: light tan (buff).
Total solids: 485 parts per million (ap-
proximately 63 grains).
Fluorine: 2.(5 parts per million.
Fluorine to total solids : 20 to 2,000.
Color: Pasty gray.
Parts per million total solids of Laurel Springs to Woodstown : 1 to 4.85.
Parts per million fluorine of I>aurel Springs to Woodstown: 1 to 52.
Weights of total solids of Laurel Springs compared to Woodstown : 1 to 3.5.
Glass of Laurel Springs water contains N total solids.
Glass of Woodstown's water contains 4.85X total solids.
132
FLUORIDATION OF WATER
Reference: Relationship of quality of ivater to dental decay — "Domestic Water
and Dental Caries"— USPHS
[Figures by H. Trendley Dean, Arnold, and Elvove,
Apr. 11, 1941 (now including figures from p. 27)]
In Illinois
Parts per
million
total solids
Parts per
million
fluorine
Dental ex-
perience
rate perma-
nent teeth
decayed
per 100
children
Number
examined
Number
having
decayed,
missing,
filled teeth
Number of
decayed,
missing,
filled teeth
Percent of
deftxyed,
missing,
filled teeth
Elmhurst
Maywood
Aurora
Joliet
Elgin
Evanston
Oak Park
Waukegan
737.6
723.2
729.6
566.0
180.0
153.6
152.8
155.2
1.8
1.4
1.2
1.2
.4
0
0
0
252
258
281
323
444
673
722
810
154
139
340
233
2.50
208
208
229
112
100
255
191
223
200
202
223
387
352
957
785
1,113
1,399
1,508
1,891
73.0
73.5
75.0
81.5
89.0
96.0
96.0
97.5
Reference: Result of 1950 survey of American islands of Samoa presented by
Dr. G. Losee at 1952 convention of American Academy of Nutrition and re-
leased with permission of Dr. H. Trendley Dean
Legend
c/o DMF teeth
DMF in 100
DMF ind in 100
Tot?l dissolved solids (103 C)
Loss on ignition
Fixed residue
Silica (SiOj)
Iron (Fe)
Aluminum (Al)
Calcium (Ca)
Ma gnesium (Mg)
Sodium and potassium (calculated as Na)
Carbon" te (cocoa)
Bicrbon-te (HCOa)
Sulfate (SO4)
Nitric (NO3)
Chloride (CI)
Phosphate (P04)_.. _ _
Fluorine (F)
Urine analyses:
Fl male urine
Fl female urine
Aoa
0.4
10
6
164.0
40.0
124.0
44.0
0.1
0.0
14.3
9.6
19.4
0.0
109.8
1.6
0.9
20.0
0.4
0.0
1.41
0.45
Amouli
1.6
36
18
112.0
24.0
88.0
36.0
0.1
0.0
11.4
4.4
6.3
0.0
36.6
1.6
0.9
21.5
0.4
0.2
0.94
0.86
Fagasa
1.7
36
16
98.0
68.0
88.0
32.0
0.1
0.0
8.6
2.6
11.0
0.0
54.9
1.6
0.7
10.0
0.3
0.0
0.36
0.50
Pavaiai
4.9
118
50
72.0
20.0
52.0
20.0
0.0
.0.0
8.6
2.6
4.5
0.0
30.5
2.1
0.9
8.3
0.6
0.0
0.46
0.47
Leone
5.5
125
39
76.0
24.0
52.0
24.0
0.0
0.0
5.7
1.7
8.8
0.0
40.7
1.6
0.7
0.0
0.3
0.0
0.37
1.07
Utulei
7.2
167
49
80.0
4.0
76.0
40.0
0.7
0.3
2.9
1.7
8.0
0.0
23.2
4.9
0.4
8.5
0.0
0.0
0.68
1.58
Common trends :
Teeth get worse.
Calcium gets less.
Magnesium gets less.
Chloride gets less.
Partial trends (getting less) : solids, residue,
silica, bicarbonate.
Reference: On urine analyses {parts per million fluorine)
American IslancLs of Samoa (6 sections) :
Fluorine content of water : 0.0, 0.2, 0.0, 0.0, 0.0, 0.0.
Fluorine content of urine: Male, 1.41, 0.94, 0.36, 0.46, 0.37, 0.68; female,
0.45, 0.86, 0.50, 0.47, 1.07, 1.58.
Woodstown. N. J. :
: 2.6.
Male, 2.3, 2.9 ; female, 2.2, 1.8.
Fluorine content of water
Fluorine content of urine :
Philadelphia, Pa. :
Fluorine content of water
0.0 to 0.2.
Fluorine content of urine : Male, 1.2.
FLUORIDATION OF WATER 133
Fifth General Hospital,
APO 154, Bad Cannstatt, Gekmany,
May 11, iy.')4.
Hon. Chakles A. Wolvebton,
Camden, N. J.
Deak Mk. Wolverton : Enclosed are five copies of original article that started
the fluorine story in hiiili .war. Please attach them to mimeos that go with tape
recordinpc. It is" here that Dr. Taylor's misinterpretation started.
Your two most important witnesses against fluorine are still living. One is
the same Dr. George W. Heard, of Hereford, Tex., and Dr. Chester Pierle, of
Canyon, Tex. Dr. Pierle performed the only animal research work sponsored
by the American Dental Association. Part of his results were published in July
192(i in ADA Journal. The same men who have since promoted this criminal
farce saw and bypassed his flndings. The other investigaters that worked with
fluorine and published its harmful effects in July 192(5 in a dental journal are
JMargaret Smith, et al.. of Arizona (well known). No sponsor of fluoridation
(or group) iiave published the results of one long-term experiment with analysis
of body tissues (teeth, bones, kidneys, spleen, livers). I had published the only
results of three generations on artificial fiuoridation. The United States Army
has much on the subject — can be obtained from a Colonel Gordon, Medical Field
Service School, Fort Sam Houston, Tex. It has to do with killing rats. Using
this particular fluoride compound the Army puts a container of water containing
this "tasteless"' material in a 20-foot (diameter) circle that is covered with
DDT powder. The rats die before they reach the outside of circle and the in-
fected lice that leave the animals are killed by the DDT. It took the Dalare
Associates (chemists) 8 months to detect this fluoride compound in dogs even
when they knew what they were looking for. It is so potent that not only the
animals are killed, but .so are the animals that eat of that animal or if a chicken
should eat, accidentally, of poisoned food, the animal that eats of that chicken will
also die.
It is a lesser degree of destruction from another fluoride compound that
the brewers of this country owe their ability to make beer quickly — but animals
that eat of these beer slops into which most of the fluoride goes become ill, their
body and teeth show the harmful effects, etc. (June 15, 1951), reported by Naval
Research, Bethesda, Md. The analyses were conducted by United States Gov-
ernment— the hai'mful eft'ects rejxirted to animal raisers, not humans.
To .fust make it illegal or unlawful to allow fluoridation is not the answer —
the promoters .should be brought to trial and made to prove their past asser-
tions liy works — not words. If the long-term bodily permanent harms are as has
been shown, then such retribution as possible should be made and such organiza-
tions that are sponsoring same (fluoridation) should stand the penalty of their
crime. They are now hiding behind the petticoat of "health."
T'nfortunately. the fluorides placed in drinking water in recommended amounts
will not kill an individual. The harmful eifects will show up in the next gen-
eration as it does in animals. The effects are permanent. Your loss of physical
stamina and manpower will be more aftected in the next 20 to 40 years than
any war could cau.se. I know you can't believe it — it would only take 1 year
of controlled laboratory experiments to prove it — either by our Government or
the sponsoring (ADA, AMA, USPHS) organizations. They have spent millions
to try to promote fluoridation and keep the public uninformed. They have spent
nothing on learning tlie facts.
Some day you will be most happy to have had the privilege of being chair-
man of connuittee into which this bill was directed.
Most sincerely.
Dr. (Lt. Col.) RoHERT J. H. Mick.
Juxction City, Ivans, (until March 23).
Laurel Springs, N. J. (April 4 to 14).
A copy of this letter is being sent to you officers and directors of the Odontologi-
cal Society of Western Pennsylvania. I trust that you will see flt that this is
pul)li.sheil in your journal so that your members may at least know that there
is another side to fluoridation and let them form their own opinions. This letter
is in reference to Editor's Notes, by your editoi-. Dr. Isaac Sissman, and the article
by Dr. Gerald Cox, of Pittsburgh, on fluoridation in your February issue.
Inasmuch as I am now a lieutenant colonel in the Dental Corps of the United
States Army, the opinions or assertions contained herein are mine and not to
134 FLUORIDATION OF WATER
be construed as being official or as reflecting tbe views of the Department of the
Army or the Army service at large. *■'
Both of these gentlemen's writings are a prime example of how to withhold arri
truthful information and how to continue to misinform and confuse you and"*
the public. The eilitor has taken it upon himself to criticize the criticism of
Dr. Gerald Cox and vehemently waves the flag in his behalf. There is no other
man in the world today that has devoted himself to the amount of practical
research work on fluorine as has Dr. Dillon (whom Dr. Cox criticizes), and.
Xmless you gentlemen are shown the complete series of all of Dr. Dillon's work
(published in English dental journals), you, too, will continue to expose yourself
to this same type of influence as Dr. Gerald Cox has been exerting on his
"gullibles" and uninformed students for some years.
And if Dr. Sissman knew anything (except what he's been told or given to
read by such as Dr. Cox) at all on the mechanics of water and its relationship
to quality of teeth (not disease prevention), he himself wouldn't be so gullible
as to print the resolution of El Paso Connty Medical Society as further confirm-
ing the virtues of this miracle mineral, fluorine. The most important part of
this Colorado Springs story isn't being told you. And if your editor knew the
story about Dr. Edward Taylor and his questionnaire and what he was trying
to cover up and what he has attempted to keep from you, your editor wouldn't
print such a statement as. "It is unfortunate that even dental journals resort
to spreading fear and doubt, etc.," and, "There are silly charges made by, etc."
I am one of that group making "silly" charges, but with e litors such as Dr. Siss-
man how can they he brought before the bulk of professional men who are sup-
posed to have the intelligence to read all sides of so vital a question as fluorida-
tion and then form their own opinions'? Information of this type is distributed
at the individual's expense and not by paid employees of some organization.
The Journal of American Dental Association's editor said of my own i-esearch
work, "Very interesting reading, but unsuitable for publicaticm." Public health
service representatives of New Jersey and Kansas have used pressure to "hush
me up" and keep more of my work from being printed or heard. Of course, when
I originally went along with the story, I was a "good fellow."
I congratulate your organization for providing space in a journal for men like
Dr. Sissman and Dr. Cox to air their personal views, as neither one presented
anything original or constructive. Of course, Dr. Sissman doesn't want space
used for any "silly" truthful facts.
I am to speak in Philadelphia Tuesday, April 13, against fluoridation, and will
there present such truths as the following: That this whole "fluorine" story
could have been built up around one of a half dozen minerals if it hadn't been
that fluorine in excess is conspicuous by its mottling effects, and thus was born
the "endemic" areas. From here on in the blind I'esearch workers could not
see and have made no efforts to have their eyes opened. They have been blinded
b.y that brown "fluorine tree" beyond which they cannot see the green forest.
Drs. Dean, Ast, Elvove, Arnold, and all the others (Dr. Cox is at head of list;
men like Dr. Sissman at bottom) will some day be known for what they are —
originally conscientious, fine men who used their professional associations to i>ro-
mote the greatest farce and life-destroying method that has ever been propagated
in the name of health. And I will continue to repeat this accusation (which is
in hands of all groups accused) : "I accuse the United States Public Health
Service, the American IMedical Association, the American Dental Association,
and all groups or individuals sponsoring the artificial fluoridation of water of
knowingly or unknowingly misinforming you, the public."
Dr. Robert J. H. Mick.
P. S. — If Dr. Gerald Cox is so sure of himself, have your group arrange for an
open forum between him and myself to be held in Philadelphia between April 5
and 14. before I go to Europe with Armed Forces. lie has never faced anyone
who knew the facts. His refusal will confirm my accusations. Otherwise, at
your request, I will criticize, paragraph for paragraph and line for line. Dr. Siss-
inan's editorial and give you the references that you may verify same for
yonrself.
You all know of the fourth annual conference. State dental directors, with the
Public Health Service and the Children's Bureau, which convened in Federal
Security Building, Washington, D. C, June 19.51, with Dr. John W. Knutson,
Chief. Division of Dental Public Health, Public Health Service, and Dr. John T.
Fulton, Dental Services, adviser. United States Children's Bureau, as cochair-
man, presiding. Among leaders attending the conference were Dr. Leonard
FLUORIDATION OF WATER 135
Scheele, Surgeon General of the United States Public Health Service ; Dr. David
Ast; Dr. Fred Wertheimer ; Dr. DeCamp ; Dr. Glover Jones; and Dr. Bull. It
•asDr. Bull's advice: "Now, where dentists do not seem interested (in fluorida-
lon) , do not let that stymie you. What we do in a case like this is to arrange for
the PTA or some group to ask for some of us to come in and talk about fluorida-
tion. In this way you get in without forcing yourself, and you can build a fire
under the dentists. ' That is promotional work."
Also, "The question of toxicity is on the same order. Lay off it altogether.
Jii^t pass it over. 'We know there is absolutely no effect other than decay,'
you say, and go on. Don't bring it up yourself." Also, said Dr. Bull, "This
toxicity question is a difficult one. I can't give you the answer on it" ; and, "So
when vou get the answer on the question to toxicity, please write me at once,
because I would like to know." And he also makes, plus many, many other
incriminating statements, "* * * and let me tell you this : The medical audience
is the easiest audience in the world to present this (fluoridation) to."
Any man can make a mistake. It takes a truly big man to publicly admit
when he's been wrong. But to continue to sponsor a program to save face at.
the possible expense of the health of future generations should be criminal.
R. J. H. M.
This is a copy of a letter sent to me by Dr. Gerald Cox.
Dr. Robert J. H. Mick.
March 5, 1954.
Dr. Robert J. H. Mick,
8 Grant Drive, Junction City, Kans.
and
Officers and Directors,
Odontological Socictii of Western Pennsiilvania:
Each of you latter has presumably received the mimeographed comment of
Dr. Robert J. II. Mick concerning the editorial and my comments on the Dillon
article in the November issue of Dental Digest.
We are accused of withholding "truthful information."
The article was written in response to an inquiry from Dr. Ralph Rosen, of
St. Louis, and was (juite naturally limited to a critical evaluation of the Dillou
article. The evaluation was made on the basis of all of Dillon's papers which
were available to me. If you will I'ead my comment in tlie bulletin and Dr. Mick's
comment, you will see that he has nothing to say about the facts embodied in the
ratios of calcium and fluorine in blood and milk. These, I say, are facts, not
opinions, and cannot be overthrown by any statements of opinion, however violent
they may be. As Dillon has not given these simple chemical facts, I have con-
cluded that he is not a chemist in the sense of understanding what he does when
he uses chemicals and chemical apparatus.
The space available to Drs. Sissman and Rosen in their respective journals
did not permit giving all the "truthful information" about fluorine and life. Dr.
Sissman even omitted the literature references to save space. However, if you
want to see summarizations of the "truthful information" about fluorine and its
relation to life, you can find it summarized in The Toxicity of Iluorides in Rela-
tion to Their Use in Dentistry, by myself and Harold C. Hodge, of Rochester,
N. Y., published in Journal of American Dental Association 40 : 440-451, April
1950, and in my chapter. Fluorine and Dental Caries, publi-shed on pages 325-414
in A Survey of the Literature of Dental Caries, Publication 225, National Acad-
emy of Sciences-National Research Council, Washington, D. C, 567 pages. If
any doubt remains in your minds about the fairness of my interpretations of the
facts of fluorine in either of these articles, or in any others that I have written,
you will find them fully documented. You can, if you care to, get the original
articles and see for yourself— in English, German, French, Spanish, and Italian,
and including the Scandinavian.
You will note that Dr. Mick uses the technique of suggestion that 'the most
important part of the Colorado Springs story isn't being told you" aad that Dr.
Taylor has tried to cover up something. Just what are these facts? Isn't it
Dr. Mick who is guilty of withholding something?
During the week of April 13, I will be attending the annual meeting of the
Federation of American Societies for Experimental Biology in Atlantic City to-
136 FLUORIDATION OF WATER
present a paper entitled "Maximum Growth of Sueklins Rats." The program
is not yet available and so I do not know when I am scheduled to give my report.
I have faced Harris, Hurme, Strongin, and Betts in debates, and, as some of you ,
may know from being present, Mick, himself, in an impromptu brawl in the meet-A
ing" of the Academy" of Dentistry of Pitt^-burgh on Monday, May 26, 1952. If*
these people don't know the facts, then who does? I heard none of these oppo-
nents of fluoridation deal with any facts, based on water containing 1 part per
million fluorine, that are adverse to the fluoridation of water.
Dr. Mick has issued the challenge. Is it nut my privilege to indicate the
weapons? Would he consent to have his speech recorded and then played back
immediately for an analysis that seeks the facts? Would time be allowed for
full treatment?
Dr. Mick has lifted from context some words from Dr. Bull. The real meaning
of Bull's statement is that there are communities, such as Stevens Point and
La Crosse, Wis., Seattle, Cincinnati, and Lansing, where the illogical outcries
of the opponents have deluded the people. Bull shrugs his shoulders and says,
"Let 'em suffer." So the children of these cities can go on with their fluorine
deficiencies, but not because of Dr. Bulk
You should read in the cold light of reason the words of the opponents. You
will find nothing but sound and fury.
Gerald J. Cos,
Professor of Dental Research.
(I wonder if the gentleman present at that Academy of Dentistry's meeting
also considered the discussion that Dr. Cox (not myself) sidetracked into the
limelight that evening as an impromptu brawl?
(As you remember. Dr. iMelvin Page had been invited to present his unusual
work on body chemistry. For the mutual benefit of those present, questions
should have been directed into that channel. But when Dr. Cox asked Dr. Page
what his feelings were on fluoridation, it was at Dr. Page's suggestion (not mine)
that any questions from Dr. Cox be directed to me.)
(Robert J. H. Mick.)
March 12, 1954.
Dr. Gerald Cox,
ISchool of Dentistry, University of Pittsburgh,
Pittshuryli, Pa.
Dear Dr. Cox : If the Federation of American Societies for Experimental
Biology would care to allocate sufficient time on their program or as an extra
activity, wiiereby I may present information, have it recorded, and played back
immediately for analysis, as you request, I would only be too glad to accept the
challenge. Inasmuch as you have offered to accept the challenge and have "indi-
cated the weapons" of the recording, to which I agree, I think it would simplify
my presentation by having you prepare the five most important reasons (or more)
why you believe fluorine should be artificially added to drinking water and send
them to me by April 7.
If the Federation of American Societies for Experimental Biology do not see
fit to allow time for a presentation by me on why and how the sponsors of
fluoridation are knowingly or unknowingly misinforming the public, basing pres-
entations as nearly as possible on discussing the reasons submitted by you on why
there should be artificial addition of fluorides, then I will still ask you, Dr. Cox,
to arrange for an open forum with dentists and physicians invited to be held in
PhiladeUhia. The same conditions stated by your and myself would be the
procedures of the program.
Due to the date I am leaving for overseas assignment, the program would have
to bs arranged between the dates of April 5 and 16, with the exception of Tuesday
evening, April 13.
I trust that you will contact the Federation of American Societies for Experi-
mental Biology ; that their program chairman, if he so desires, will, in turn,
contact me.
In any case, I await your reply of my acceptance to your challenge.
Address until March 28, 1954 : 8 Grant Drive, Junction City, Kans.
Address after April 3, 1954: Laurel Springs, N. J. (phone 4—0167).
IMost sincerely,
Robert J. H. Mick, D. D. S.
FLUORIDATION OF WATER 137
The Chairman. Is Dr. Brusch present ?
Di'. Brusch. Yes, Mr. Chairman.
The Chairman, Doctor, are yon for or against the legislation?
Dr. Brusch. I am for it.
Tlie Chairman. In snpport of it?
Dr. Brusch. Yes, sir.
The CiiAnaiAN. AVere yon })resent yesterday when we annonnced
that there would be a limitation of 15 minutes for each witness?
Dr. Bruscii. No, sir.
The Chairman. Well, because of the great number who wished to
be heard, and the available time being limited, it was necessary to
fix a period of 15 minutes for each witness.
Now, if you were not among those witnesses whose names were
given to me yesterday and this is an addition, I will have to see how
we can work that out. But in view of the fact you are present and
you are director of the Cambridge Medical Center, we will see that
you have an opportunity to be heard.
Now, are you speaking for the legislation ?
Dr. Brusch. Yes, sir.
Dr. GiNNs. Mr. Chairman, when you called Dr. Brusch's name
yesterday I rose to inform you that he could not be here before
Wednesday. I believe I made that clear.
Tlie Chairman. Yes; I remember you did. I had forgotten that
for the moment. So that does not create any problem for us to hear
him this morning.
STATEMENT OF HON. LESTER C. HUNT, A UNITED STATES SENATOR
FROM THE STATE OF WYOMING
The Chairman. Senator Hunt has just arrived in the committee
room.
Senator Hunt is a very busy individual and we will give him the
opportunity of testifying at this time.
Senator, are you for or against the bill ?
Senator Hunt. I am opposed to the passage of the bill, Mr.
Chairman.
The Chairman. Well, as I said before you came into the room this
morning. Senator, we were hearing the proi^onents of the legislation
today, but it is our usual custom to hear Members of Congress, and
especially Members of the Senate who dignify our hearings by their
presence, we might say, out of turn. So that I will ask the clerk to
keep a record of the time that Senator Hunt utilizes and charge it
against the opposition.
Senator Hunt. Thank you veiw kindly, Mr. Chairman. I was not
aware of the situation, otherwise I could have been with you earlier
this morning. I appreciate a very great deal your consideration.
The Chairman, You are entitled to be heard.
Senator Hunt, ^ow, Mr, Chairman and members of the committee,
I am here this morning to op])ose the enactment of H, R, 2341. As
a Member of Congress I am op]30sed to bills which, to my way of
thinking, encroach upon local rights. I think that is one of the effects
of this bill. I believe that people in their own communities should
have a right to decide for themselves whether or not they wish to
have their water supplies fluoridated. It is their children's health
138 FLUORIDATION OF WATER
that is involved. If this bill were to be enacted, the Federal Gov-
ernment would be telling States and local communities that they
could not add fluorine to their local water supplies. In my judgment,
the question of fluoridation of local water supplies is not a Federal
question and I would therefore recommend that your committee
decide adversely to H. R. 2341.
On the other hand, gentlemen, as a licensed dentist who engaged in
private practice for a good many years, 2 years in the Armed Forces
and 12 years in private practice — I have a strong professional belief
in the benefits to be brought to the public by the adjustment of the
fluorine content of public water supplies. I have carefully studied
the scientific literature on this subject and have concluded that the
]Drocedure is both safe and beneficial.
And, I should like to say, Mr. Chairman, that this was not a prob-
lem befoi-e the country at the time that I was practicing dentistry.
The research work was just starting on this a few years after I gradu-
ated from the university.
In my own State of Wyoming, the capital city of Cheyenne has
naturally in its water supply a fluoride ion content of about one part
per million, the same as is recommended to be added to water-deficient
supplies. The people of Cheyenne are justly proud of their healthy
teeth, caused in large part by nature's munificence in providing this
element of nutrition.
Mr. Chairman, fluoridation of public water supplies has been ap-
proved by every scientific society of recognized standing in the field
of health. These include the American Dental Association, the dental
societies of all 48 States, the District of Columbia, the Commonwealth
of Puerto Rico, the Territories of Alaska and Hawaii, and the Canal
Zone.
Mr. Chairman, the American Medical Association looks with great
favor upon fluoridation of water and I am sure that the recommenda-
tion of that great organization carries a lot of weight with reference
to health matters before the Congi-ess of the United States.
Also included is the Public Health Service, the American Academy
of Pediatrics, the Association of State and Territorial Health Officers,
the American Public. Health Association, the American Public Wel-
fare Association, the Commission on Chronic Illness, the National
Research Council, the American Hospital Association, the American
Nurses Association, the Inter Association Committee on Health, the
American Waterworks Association, the State and Territorial Dental
Directors, the American Society of Dentistry for Children, the Amer-
ican College of Dentists, the dental section of the American Associa-
tion for the Advancement of Science, and numerous State and county
medical societies.
I should like to interpolate, Mr. Chairman, by saying that surely
these great scientific organizations with tremendous research facilities
at their command would not recommend anything having to do with
the liealth of the people of the United States if they diet not believe
wholeheartedly in what they were recommending.
On these grounds, therefore, (a) That this is a local problem which
should be determined locally; (b) as a dentist familiar with the prev-
alence of dental caries who would like to see its incidence diminished
by the use of community water fluoridation ; and (c) because its safety
and efficacy has been endorsed by so many eminent scientific associa-
tions, I Urge you to vote against H. R. 2341.
FLUORIDATION OF WATER 139
I am not going, Mr. Chairman, to attempt to overwhelm you with
statistics on the prevalence of dental caries nor attempt to say what
will be said more effectively and factually, of course, by the scientists
who will testify before you. But, I do want to assure you that, as a
practicing dentist, I have seen and treated a good many thousands of
cavities in teeth.
I have never known a tooth in which decay had begun to get better
by itself, or for that matter for the decay process to stop until it was
treated by a dentist.
Fluorine added to the water supply will not stop decay which has
alread}' begun but it will prevent in future generations the widespread
prevalence of dental decay that we know today. It will save eventu-
aUy, might I say to the committee, literally millions of dollars to those
who would in the future need dental care, if the water is not pro])erly
fluoridated; but over and above what E have said to the committee,
it will prevent suffering; it will prevent malformed bone structure of
the oral cavity, due to early loss of permanent teeth, and we will pre-
ment many facial distortions. We will be able in so many, many cases
to make for a more pleasant appearance of the face, if we do not have
the distortion of the oral cavity of the bone structure.
In closing, Mr. Chairman, and gentlemen of the conmiittee, as I
walked over here this morning, I passed that Avonderful statue placed
by the State of Georgia for Dr. Crawford Long who in 1842 first suc-
cessfully demonstrated the use of sulfuric ether in general anesthesia.
My point is this, Mr. Chairman, at that time certain publications,
and from the pulpit, the use of general anesthesia was rather generally
condemned.
Prior to that, a few years, Dr. Horace Wells, a dentist, first success-
fully used nitrous oxide, and then the same hue and cry went up from
certain people in the country.
I also definitely remember reading when we first started in our
public schools, especially, and even before that, when we were com-
batting the most, perhaps the most prevalent disease at that time, the
disease of smallpox, the vaccination for the prevention of that disease
was frowned upon widely and generally and, Mr. Chairman, even
doAvn to today there is some opposition to vaccinating our children
for smallpox.
I think, Mr. Chairman and gentlemen, that the opposition to the
fluoridation of our water supplies today falls to some extent within
the same category that I have just mentioned with reference to small-
pox and anesthesia.
I thank you, Mr. Chairman and members of the committee for the
time you have so generously given me.
The Chairman. Are there any questions?
Mr. Heselton. Mr. Chairman.
Tlie Chairman. Mr. Heselton.
Mr. Heselton. Senator, you mentioned the fact that Cheyenne's
water supply had a natural supply of fluorine. Is it in quantities
similar to the quantity that is advocated be placed in waters which
are without fluorine?
Senator Hunt. It happens in this particular case to be almost
identical ; I think exactly the same as is recommended in the fluori-
dation of water, which is about one part per million.
48391—54 10
140 FLUORIDATION OF WATER
Mr. Heselton. Has there been any effort to try to defluoridate, if
that is the proper term, to try to get the fluorine out of the water?
Senator Hunt. I have never heard of it, sir.
Mr. Hesp:ltox. Is the existence of natural fluorine rather wide-
spread in Wyoming?
Senator Hunt. Yes; and some situation, I would say to the gentle-
man, that, of course, you can have ill effects from too much fluorine
in the water. I happen to have practiced in one of those areas, a
mountain community, where many of the teeth of the patients I took
care of, or treated their teeth, there was overfluoridation of water,
which is not beneflcial to the teeth. But, of course, the amount of
fluorine that is put in our waters today is naturally very carefully
and scientiflcally handled, so that there is no danger from that angle.
The Chairman. Any further questions, gentlemen? If not, we
thank you, Senator, for your appearance before our committee this
morning and, by way of confirming the statement that you have made
as to the viewpoint of the American Dental Society and the Ameri-
can Medical Society, in the several State organizations, I would say
that we have received many statements confirming what you have
said from those different organizations, and the American Dental
Society has witnesses here today to testify in opposition to the bill.
Senator Hunt. Thank you.
Mr. Priest. Mr. Chairman.
The Chairman. Mr. Priest.
Mr. Priest. Senator, I appreciate your statement this morning. I
know you have been greatly interested in public-health matters of all
types since you have been a Member of the Senate.
I simply want to make a very, very brief observation, because I
feel it is appropriate at this place.
You stated that millions of dollars might be saved to the people
of the country insofar as dental bills are concerned if fluoridation of
water is permitted, provided, of course, that the people want it in
the local communities.
The dental societies that have opposed this bill — and I think most
of them have, including the national association — have been enthu-
siastic in their approval of the practice of fluoridation of water.
I think that they deserve a great deal of credit for a very unselfish
attitude in that respect, because the millions of dollars, of course, if
you look at it from that viewpoint, the millions of dollars that the
public might save, on the estimates that have been made, are millions
of dollars that otherwise might be fees for dental services.
I feel that the American Dental Association deserves a pat on the
back, if I might put it that way, for what appears to me at least to be
a most unselfish attitude; an attitude that is in the public interest; and
I wanted to make that point a matter of record while you, as a repre-
sentative of the profession and a Member of the Senate, are present
before the committee.
Senator Hunt. Might I just add to the statement that you have
made, by saying that the most widely spread, the most prevalent of
all diseases are dental diseases, and as you gentlemen well know, in
World War II especially, the greatest number of men who were found
ineligible for the draft were found to be so due to dental conditions.
Thank you, Mr. Chairman.
The Chairman. Thank you, Senator.
FLUORIDATION OF WATER 141
STATEMENT OF DR. CHARLES A. BRUSCH. B. S., M. I)., DIRECTOR,
CAMBRIDGE MEDICAL CENTER, BOSTON, MASS.
The CiiAiKMAx. Our next witness will be Dr. Brusch. Dr. Brnscli,
I note from a copy of your statement which has been presented to me
that it is a very worthwhile statement ; but would take considerable
time to tjive in its entirety. For that reason I call to your attention
the limitation of 15 minutes for witnesses, so that you may utilize
that time to the best advantage in whatever way you see ht. You
may proceed.
Dr. Brusch. Mr. Chairman and gentlemen of the committee, those
"who engage in the controversy that exists today on the fluoridation of
connniuial water supplies must take into consideration the fact that
fluorides are divided into two classes — natural, and inorganic or
artificial.
Organic fluorides, such as calcium fluoride, or calcium phospho-
fluorides, are found in our daily foods and in drinking water in some
areas. They are not readily soluble, and they do not dissolve readily
in solution. Calcium fluoride 0.0016 gram per 100 cubic centimeters
of water is the solubilitj'.
It appears that in areas where there is naturally fluoridated water
the individuals develop a certain amount of immunity to this water
because the calcium fluoride here is found in company with other
minerals.
When drinking artificially fluoridated water, such as sodium fluo-
ride, this immunity seems to be lost. Calcium fluoride is held to-
gether by covalent bonds which gives it a certain chemical propei'ty.
On the other hand, the artificial, or inorganic, sodium fluoride is
a highly toxic, protoplasmic poison, freely soluble. The amount that
is soluble is 4 grams per 10 Ocubic centimeters of water. This sodium
fluoride is generally a byproduct of bauxite. If we break down fluo-
ride, we find that it contains sodium 54.76 percent and fluoride 45.24
percent. Artificial .sodium fluoride is very readily ionizable and
diffuses readily in solution.
The difference is apparent. The first is a natural product, calcium
fluoride, which is held together by covalent bonds, and not very solu-
ble. Artificial fluoride is inorganic, readily soluble, contains no
covalent bonds; 1 part per million contains 0.25 miligram of hydro-
fluoric acid to the glass of water.
INDIVIDUAL VARIATION
Individual variations run as high as several hundred percent in
susceptibility to medication, foods, chemicals, drugs, and so forth.
Since sodium fluoride is a protoplasmic poison affecting every cell in
the body depending to an extent on the cells' carbohydrate demand.
Each system is affected in a different way, for example, the skeletal,
the miiscular, the vascular, the nervous, the circulatory, perspiratory,
gastrointestinal, genitourinary tract, and reproductive organs.
Whether as air, liquid, or solid, the amount and method by whicli it
is taken into the system is of great importance, as fluorides are used
in practically every industry, such as glassmaking, tanneries, bleach-
142 FLUORIDATION OF WATER
eries, rubber works, varnish making, plastics, emory wheels, flux,
and so forth.
In air it is taken into the respiratory tract as dust or fumes. As a
liquid it is taken in by beverages, milk, fluids and liquid ; as solids, in
foods, vegetables, and fruits that have been sprayed or crops raised
in a highly fluoridated area or fertilizers which contain high percent-
ages of fluorine.
In highly fluoridated areas, such as Texas and New Mexico, crops
that are growni there and shipped to this area are fonnd to contain
large quantities of fluorine. When boiled and cooked in water arti-
ficially fluoridated, their fluorine content is greatly increased.
For instance, if the water is 1 part per million, it becomes in 20
minutes' boiling 2 parts per million. Such food as oatmeal, cereals,
and so on, will absorb that additional concentration of artificial fluo-
rides in addition to their own original high content of fluorine.
The concentration is of importance because the greater the amount
taken in, the greater amount is absorbed to a certain level. The dura-
tion of time it stays in the system is also a factor in the amount that is
absorbed by the system. The factors are in pH of the media is acid
in the blood or in GI system, more of the fluoride is absorbed.
If the fluoride is taken in with slow-absorbing food or with calcium,
minerals, and vitamins, such as Bl, B2, or B6, less of the fluoride is
absorbed. If the system, at the time the fluoride is taken in, has a low
calcimn or mineral content, more of it is absorbed.
AGE IS IMPORTANT
Age of the individual is important because an infant or child with
growing connected tissue absorbs more than an adult or senile person.
The sex of the individual is a factor. Females or individuals of a
high metabolism absorb more than males or those with normal metab-
olism. People with a high temperature, such as those with a fever,
absorb more.
People with fevers and healthy people have different reactions.
Sufi^erers from chronic diseases, like rheumatic fever, diabetes, heart
condition, kidney trouble, and blood conditions, would absorb more.
The weather, humidity, heat or cold, must be considered. The
warmer the day, the greater the amount ingested. Change in weather
conditions bring about a like change in the reservoir where the arti-
ficially fluoridated water is stored.
Again, the action of radioactive substances, the rays, such as cosmic
rays, rays from the chemicals themselves, must be taken into con-
sideration.
The diet and nutritional makeup of an individual is another factor.
Sodium fluoride has greater effect on the poorly nourished person
who lacks calcium and minerals and vitamins, for they absorb more
of NaF2 (sodium fluoride).
In autopsies performed on normal and abnormal individuals there
is a very minute difference.
FLUORIDATION OF WATER 143
Normal
Abnormal
0.6
1.6
3.5
4.5
1.6
2.6
Blood
3.6
4.6
This shows that it is a problem of activity, rather than of concen-
tration.
ESSENTIAL TARTS OF THE BODY AFFECTED
Essential parts of the body affected are:
1. Calcium, minerals, connective tissues, bones.
2. Enzymes, vitamins.
3. Cells, endocrine glands.
4. Metabolism, of carbohydrates, of proteins, and of fats.
When the sodium fluoride is taken into the system, it is absorbed
in the upper part of the small intestine, and is carried by the blood
stream to the different cells, organs or tissues in the form of calcium
fluoride, robbing the system of calcium.
At the cell some of it may enter the cell or remain on the outside
of it as an insoluble precipitate, affecting the feeding and the breath-
ing of the cell. As a result, the cell may lose some of its functions or
it may die. Some of the calcium fluoride is carried to the connective
tissues and bones and here it is stored. Some of it is excreted through
that gastrointestinal tract, some through the urinary tract, some
through the perspiration, and one-tenth part is excreted through the
salivary glands.
We find that, if there is a deficiency of calcium in the system, it
•will join up with other minerals, displacing them from their essen-
tial use, disrupting their function.
The femur bone contains 15 times more calcium fluoride than any
other part of the body.
On the enzymes we find that it joins up with metallic portion of
the enzyme which is made up of vitamins and proteins. By so
doing, it nullifies their action. Some of the enzymes affected are
endolase phosphatase, lipase. We find that 1 part per 15 million will
reduce the action of the enzyme, lipase, 50 percent. It affects enzymes
adenosine triphosphate.
It prevents the absorption or assimilation of vitamins Bi, B2, and
Be, and it prevents the storage of vitamin C. It affects the cyrochrome,
oxidation system of the cells. It interferes with certain enzymes of
the kidneys which deal with absorption.
It interferes with the action of the thyroid, parathyroid, adrenal,
pancreas.
It counteracts the thyroxin of the thyroid, parathyroid, adrenal,
pancreas.
It counteracts the thyroxin of the thyroid, and interferes with the
{:)roduction of cortosterone. It prevents glycophosperic acid from
)reaking down into phosphoglycerin acid and into lactic and peruvic
acids. These are steps that are interfered with in carbohydrate metab-
olism.
It interferes with the purine metabolism so that we get an accumula-
tion of uric acid which mav form kidnev stones and cau.se ffout. There
144 FLUORIDATION OF WATER
is an increase of cholosterol in the blood. If the fluoride joins with
acetic acid — vinegar — it forms Huoroacetic acids which prevent the
breakdown of citric acid into other forms. Citric acid is a poison
which injures the heart muscle.
The intake of 0.25 millograms of hydrofluoric acid in each glass
of 1 part per million fluoridated water starts off the chain of body
destruction. This strong acid in the stomach may or may not aggra-
\ate ulcers. Then with a change of body functions as we have men-
tioned with reference to normal activities it may produce allergic
activities.
The recognized allergic symptoms of varying kind and degree
manifested are :
1. Vasomotor disturbances and rhinitis.
2. Bronchitis and asthma.
?>. Gastrointestinal disturbances.
4. Dermatitis-hives-acne.
5. Alopecia.
6. Diabetes.
7. Anemias.
BONY CHANGES
Fluoridation may slow growth of bones because of disturbance of
phosphorus-calcium ratio, resembling arthritic changes.
BLOOD CHANGES
In studies done of about 500 cases, everyone tested was allergic
to sodium fluoride from mild to severe reaction. Blood of people
living in fluoridated water areas may take from 6 to 20 times longer
to coagulate.
HEART AFFECTED
Loss of calcium increases citric acid poisons, injures and destroys
adesintriphosphate enzyme. Increased cholosterol of the blood may
contribute to high blood pi'essure and cause hardening of the arteries.
The sodium part of sodium fluoride and accumulates in tissues
retaining fluid in cases of cardiac failure, kidney failure, liver failure
or any form of ascites wherever it is coiuiterindicated.
KTDNEY TROUBLE
The uric acid accumulation or hydrofluoric acid, or injured enzymes
and stone formation will impair or damage kidneys so they cannot
excrete the fluorides or other waste.
DIABETES
Diabetic symptoms such as high blood sugar and sugar in the urine
can appear as injury to carbohydrate metabolism.
NFJIVOUS DISORDERS
Chronic fluorine poison affects the section of the brain concerned
with volatile and the will to resist. The same area is affected by
hypnotism. Inhibition of phosphatase exerts progressive degen-
FLUORIDATION OF WATER 145
erative chancres on the nerve tissne thr()vi<ihout the body by altering
phosphorous calcium ratio and inhibitin*^ the utilization of vitamin
Bi. It affects the cerebral area to a large extent.
Experience on rats showed a marked deterioration in mental alert-
ness, accompanied by a state of passiveness and bewilderment.
EYE INJURY
There is a question of increase in eye diseases due to artificial fluori-
dation. In Washington, D. C, fluoridated without legislation or
permission, more cases of glauconui are being reported. As yet there
are no definite statistics.
CANCER
Experiments show that sodium fluoride in drinking water shortened
the lives of animals with a tendency to cancer.
MOTTLED TEETTI
In concentrations less than 1 part per million fluorine caused mot-
tling in 33 percent of the child population of Salt River Valley,
United States of America (Smith, Smith, P'oster 1938. Bull. Univ.
Arizona 61).
The Pago Indians' School showed a lOO-percent mottling of teeth
from drinking fluoridated water 1 part per million.
DENTAL HEALTH
Diet, vitamins, antibiotics, dental hygiene, and lessened acid in the
mouth will give far better results than any other program. Brushing
the teeth after every meal and eating less candy and sweets will help
stop decay.
Sodium fluoride is not essential for body function, but calcium is,
and we cannot have good teeth without calcium being present.
ARTIFICIAL FLUORIDATION
Artificial fluoridation is fraught with dangers. Sodium fluoride
is a highly toxic protoplasmic poison, 15 times stronger than arsenic,
having radioactive properties. The smaller the dose, the greater the
activity.
The danger lies not so much in injury to the somatic cells that can
partly repair themselves, but to the embryonic cells that undergo
mutation and will show up in generations to come.
PREMATURE BIRTHS
Massachusetts does not show premature births as among the first
10 leading causes of death.
The ratio is 26.7 percent average throughout other sections of the
country.
In Texas the ratio is 35.1 percent ; in New Mexico, 55.9 percent.
Both of these States are highly fluoridated areas.
We know that malnutrition will prevent conception, or delay it.
Plus fluoridation it would present a great danger to our birth rate.
146 FLUORIDATION OF WATER
UNSCIENTIFIO
It is unscientific and impractical to prescribe a toxic substance for
the duration of our life, as an experiment, whether we need it or not,
against our will, and without being able to stop taking it if we want
to do so.
LET us KEEP OUR WATER SUPPLY PURE — SUMMARY
Artificial sodium fluoride is an inorganic, toxic, protoplasmic poison,
easily ionizable and soluble, different from CAF 2, an organic not so
soluble substance held together by covalent bonds found in nature.
Artificial fluoridation affects every cell and system of the body :
1. Calcium, magnesium, and other minerals.
2. Connective tissue, bones, teeth.
3. Enzymes
(a) Endolase
(b) Lipase
(c) Phosphatase
(d) Adenosinetriphosphate and other enzymes
4. Vitamins Bi ; B2 ; Be ; C
5. Endocrines
(a) Tyroxin, thyrotropic
(h) Ephedrine
(c) Cortosterone and others
6. Metabolish and cytrocrome oxidation of cells; carbohydrates,
proteins and fats.
7. Cell oxidation interfered with causing cell destruction with
disease and death.
8. Mottled teeth — an indication of toxic content of sodium fluoride
in the water.
9. Wasteful procedure. Five-tenths of 1 percent of fluoridated
water will be used for purpose intended ; 99% percent of it is wasted.
For those who want it, there are many alternatives, such as tablets,
tooth paste, and so forth.
10. This forced experiment w^ith a protoplasmic poison which all
must ingest, in mass medication without parallel in the history of
medicine, without a doctor's prescription, can cause symptoms of dis-
ease, such as allergy, internal and gastric upsets, such as colitis,
blood conditions, gland and nervous trouble, diabetes, arthritis,
muscular w^eaknesses, shortening life of cancer animals, hardening of
the arteries, kidney troubles, and a long list of other serious illnesses.
[Applause,]
Mr. DoLLivER. I must caution the audience that we do not permit
expressions of approval or disapproval, else we could easily get into
chaos, unless such a rule is followed. Accordingly, you will please
not express approval or disapproval of what any witness says.
Now, are there any questions ?
(The paper The effects of Fluorides on the Human Body, by Dr.
Bruscli is as follows:)
FLUORIDATION OF WATER
147
TuE Effect of Fluorides on the Human Body
By Cbarles A. Brusch, B. S., M. D.
NATURAL FLUORIDES
Calcium fluoride, calcium phosphofluoride
Held together by covalent bands
Slightly soluble
Occur in first mile of earth's crust
The 20th most common element, fluorine is found in almost all foods : eggs, milk,
cheese, butter, fish, soybeans, molasses, etc.
Sodium phosphate (baking soda) contains 2,000-3,000 parts per million and
tea contains 70-500 parts per million
ARTIFICIAL FLUORIDES
Sodium fluoride
Inorganic, toxic, protoplasmic poison
Highly soluble
Accumulative
1 part per million in a glass of water contains 0.25 milligrams of hydrofluoric
acid
Byproduct of bauxite clay and aluminum
INDUSTRIAL USES
Bleacheries
Electronics
Emery wheels
Flux in foundries
Glass etching
Insect and roach powder
Plastics
Rubber work
Varnishes
HOW ABSORBED BY THE BODY
Air
Radiation
Liquids
Solids
Dust
Fluorescent lighting. ..
Chemical rays
Television...
Water
Milk
Foods.
Tablets.
Poison gas..
Other beverages. _
Sprays '
Hydrofluoric acid '
Dental applications.
Toothpaste.
' Absorbed by skin contact.
FACTORS AFFECTING ABSORPTION OF FLUORIDES
Age : Infants and elderly people absorb fluorides most readily.
Amount : Small amounts frequently ingested mean greater absorption.
Duration : The longer fluorides remain in the intestinal tract, the greater the
absorption. Example: fatty foods.
Environment: Higher temperature causes greater absorption. (Climate.)
Form : Absorption is 4 times as great in water as in solid form. When water
is boiled 10 minutes, concentration is doubled. In acid media, fluorides are
more readily absorbed.
Nutrition : Deficiency of calcium, minerals, or vitamins causes greater absorp-
tion.
Physical condition: Sickness (diabetes, rheumatism, kidney disorders, etc.)»
infections or fever cause greater absorption. Tooth decay is greater after ill-
ness. Also, per.sons with higher metabolism have greater absorption.
Sex : As a rule, the female absorbs more readily than the male.
148
FLUORIDATION OF WATER
Soil : The higher the fluorine content of the soil, the more fluorides are ab-
sorbed by food.
Type : Artificial fluorides are 2,500 times more soluble than natural, natural
dissolving at a rate of 0.0016 gram, and artificial at a rate of 4 grams, In 100
cubic centimeters of water.
Composition of the human body
Organic
Inorganic
Cells:
(a) Protoplasm
(ft) Water and minerals
Muscle
Vital organs
Skin
Appendages
Blood and lymph glands
Nitrogen
Oxygen
Phosphorus
Potassium
Sulfur, etc
Skeletal structure
Teeth (organic and inorganic)
Circulatory system
Gastrointestinal tract
Genitourinary tract
Muscular system
SYSTEMS
Nervous system
Reproductive system
Respiratory system
Skeletal structure
EFFECTS ON BODY
Body minerals : Fluorine acts as a flux combining with calcium, magnesium,
etc.
Bones and skeletal structure : Effects are 15 times greater in femur than in
teeth.
Cells : Interferes with breathing or feeding of cell ; retards or destroys other
processes ; induces capillary constriction.
Connective tissue : Impairs functions.
Enzymes : Destroys adenosinetriphosphate, endolase, lipase,* phosphatase,
urase, other enzymes.
Glands: Interferes with functions of cortosterone, epedrine, thyrotropic,
tyroxin, other hormones, liver.
Metabolism: Interferes with assimilation of carbohydrates, fats, proteins;
cytrocrome system of oxidation of cells.
Teeth : Mottled teeth, early sympton of toxic poisoning, occur in about 1 out
of 5 cases. As little as 0.4 part per million fluoride will cause mottling in about
33 percent of cases.
Vitamins : Destroys or prevents absorption of vitamins Bl, B2, B6, and C.
Bacteria Fungus "Virus
(Always present in or on the body)
when body resistance is broken down through deficiency of nutrition and
oxygen —
Inflammation
Produce :
Degeneration
Destruction
Note. — Susceptibility to allergy in individuals varies by several hundred
percent.
^ One part diluted to 15 million will cause 50 percent destruction of lipase.
FLUORIDATION OF WATER
149
Fluorides a causative fartor in —
Symptoms
Allergies ' (Loss of immunity);
Dermatitis, acne, eczema, hives
Ci a; t roin testinal disturbances -- -
Kespiratory disorders: Asthma— bronchitis
Vasomotor disturbances and rhinitis
Alopecia - ----- ---
Blood and circulatory disturbances:
Fluorine circulates through body as calcium flucridc
Cholesterol increased
Coapiilation may he retarded 6 to 20 times
Anemia— leukemia
Disturbances of circulation .. _
Bone disturbances: Mild to severe changes resembling
arthritis.
Cancer: Experiments show that fluorides shorten the life of
animals having cancerous tendencies.
Diabetes: Increase of sugar in blood and urine
Edema (from various causes): .Aggravated by sodium re-
tention.
Genitourinary and kidney:
Accumulation of uric acid
Injury to enzyme (urase)
Stone formation -
Heart:
Functions impaired due to—
Loss of calcium...
Increased citric acid poison .-
Destructiou of enzyme (Adeaosinetriphosphate)..-...
Multiple sclerosis _
Muscular disturbances -
Nerve disorders : Degeneration of nerve tissue
Reproductive disorders:
Premature birth
Sterility, due to nutritional deficiency, mineral imbal-
ance, elTects of fluorine on embryonic tissue (hereditary).
Virus infections, due to lack of immunity: Chicken pox,
colds, encephalitis, measles, mumps, poliomyelitis, etc.
' In over .500 cases tested by the Healy blood allergy method, all were found allergic to sodium fluoride
The allergies ranged from miid to severe.
Itching and swelling.
Belching, burning pain, diarrhea, colitis.
Coughing, shortness of breath.
Running no.se, eyes.
Loss of hair.
Loss of appetite, weakness, retarded
growth.
Tingling of extremities, coldness, numb-
ness.
Weakness, loss of weight, increased thirst
DiflQculty In voiding, swelling of legs.
Shortness of breath, weakness sudden
death.
Weakness, loss of function.
Muscular weakness.
Mental deterioration, passiveness, bewil-
derment.
Temperature, fever, chills.
SODIUM FLUORIDE IS A POISON
Small amounts of sodium fluoride are very active and, if constantly ingested,
may cause chronic tlunride poisoninjr, which would impair the health, and
shorten life.
Note. — The Council of Chemistry, Pharmacy, and Nutrition of the American
Medical Associaticm. has stated that fluoridated water should not be used with
certain foods which contain a liiLih percentage of fluorine, such as hone meal,
cereals, lozenges, etc.. and that in warm climates, where people drink larger
amount of water, fluoridated water must l)e u.sed with caution and tlie dosage
cut down to less than 1 part per million, so that toxic symptoms such as
mottling of the teeth will not develop.
Is it reasonable to .suppose that adding fluorine to our drinking water will
prevent tooth decay? If so, why is it that in so many cases we can get s<i
much fluorine into our systems and still have decayed teeth? Or why is it that
some people who have no fluorine at all in their drinking water have good teeth?
Since we cannot predict who will or who will not develop mottled teeth, it
would seem more parctical to give increased attention to proi>er nutrition and
dental hygiene, rather than run the risks entailed in fluoridation.
The artiiicial fluoridation of our public water supply with sodium fluoride, 1
part or l.o parts per million, is being sought for the sole purpo.se of preventing de-
cay of teeth in children. Since no contagious tlisease is involved, liowever, this is
not a public health problem Imt a personal matter. Such fluoridation would im-
pose upon the entire populati(Mi the consumption of a highly toxic protoplasmic
poison in small do.ses from the time before we are born until the time we die.
This drug, against which there is no antidote, would be forced on all, regardless
150 FLUORIDATION OF WATER
of their environment, regardless of their physical condition, and regardless of
their moral atitude — whether or not they wish to take this drug. No one would
be able to stop taking it, should he so desire. At the same time, there would be
created a false sense of security, a false impression that we do not need to con-
sider the predisposing causes, the bacterial, nutritional nor the hygienic pro-
cedures imder medical and dental care which are essential for good teeth. This
experiment would be expensive, impractical, unconstitutional, and unscientific.
It is important that this issue be settled here. It does not belong in a com-
munity, because a community is not able to receive the facts on both sides of
the issue, and because several communities using the same water supply may
disagree on whether or not lluoride should be placed in the water. This is a
national problem, because the whole population is to be tiuoridated. We must
demand the protection to which we are entitled under the Pure Food and Drug
Act, which prohibits the contamination of our foods with poison and the pollution
of our water supply.
Massachusetts General Laws, chapter 270, section 2, and also chapter 111. sec-
tion 160, make fluoridation illegal, but appeals to the State official responsible
to enforce these laws go unanswered.
We must realize that this is just a wedge and that if we adopt or submit to
this type of experimentation, it will be only a forerunner of other measures
interfering with our professional, industrial, and ordinary American way of life.
If we fail to pass H. R. 2341, known as the Wier bill, we shall be following the
customs and experiments of the dictators and the Communists. We shall no
longer he freemen.
Mr. Priest. Mr. Chairman.
Mr. DoLLivEK. Mr. Priest.
Mr. Prie8t. I think with all of your scientific knowledge, yon have
some sympathy with Members of Congress who sit through these
hearings, hearing equally eminent scientists say that certain things
are unscientific, and then others come in and say that they are very
scientific. I am sure that you can appreciate the provision of a con-
gressional committee that does not have, of course, the time to make
the very serious and long-range studies for itself that you do, but
must depend in the end, in making its decision, on the weight of the
testimony.
It may be that the committee is perhaps more able to decide the
constitutional and legal questions involved than they are the scientific
questions involved, and as you well are aware, the scientists them-
selves seem to be considerably divided on this basic question.
I just want to ask you one technical question. I have studied a
little chemistry at one time. On page 1 of your statement there is an
■expression there, a word, that does not mean anything to me, and
perhaps it should. I know you can well explain it. It is down about
the fourth paragraph, tlie word "covalent" — covalent bonds. You
state : "Calcium fluoride is held together by covalent bonds which gives
it a certain chemistry property."
That sentence does not mean anything to me, and I would like for
you to explain it to me, please.
Dr. Beusch. There is a difference between ariificial inorganic
sodium fluoride and natural calcium fluoride or calcium phospho-
fluoride. Calcium phospho-fluoride is found in plants. The plant
derives its fluoride from the soil and converts it into calcium fluoride
or calcium phospho-fluoride. When man or ar.imal consumes this
plant life the fluoride is taken up in this form. This natural form
is held together by covalent bonds, meaning that nature has caused
a. union or combination between the calcium and the fluoride that
makes it difficult to be broken down and consequently only slightly
soluble; 0.0016 grams is soluble in 100 cubic centimeters of water.
FLUORIDATION OF WATER 151
This is not readily ionizable ; that is, it does not disperse readily in
solntion. It is not as toxic. On the other hand, artificial sodium fluo-
ride, which is produced as a byproduct, is not held together as strongly
as nature's method. It has no covalent bonds; therefore it disperses
readily in solution.
It is highly ionizable and toxic ; 4 grams will dissolve in 100 cubic
centimeters of water (2,500 times more than natural) . It is not found
in plant or animal in this form. When taken into the system the
fluorine combines with calcium or other metals. One glass of arti-
ficial fluoridated water (1:1M) contains 25 milligrams hydrofluoric
acid. This is one reason why we can take so much of the natural
fluorides daily and not be afl'ected as readily as we would be by taking
in minute doses of artificial sodium fluoride 1 : IM to 2 : IM.
Calcium fluoride is the form that is found in the body. To the
body sodium fluoride is an unnatural combination which the body
has to break down. The fluoride joins with body calcium and is
carried by the blood stream to the body cells. Some penetrates the
cells and some does not. The amount ingested and the individual
susceptibility determines the toxicity to the system.
Mr. Priest. Thank you sir, that is all.
Mr. Beamer. Mr. Chairman, I just want to say that that is the
longest definition of an eight-letter word I ever heard.
Mr. Priest. As I gather, then it is your contention and that of your
organization that natural fluorine is not as detrimental, from your
viewpoint, as when artifically added because of the difference in
solubility.
Dr. Brusch. Yes.
Mr. Priest. That is all, thank you.
The Chairman. Are there any further questions ? If not, we thank
you. Dr. Brusch, for your appearance and for the testimony you have
given the committee.
I would like to call attention to the fact that the time available for
the proponents is drawing to a close and growing short, and so that
if anyone is called upon to define a word, he would probably be serving
in the interest of limited time if he would answer as succinctly as
possible.
STATEMENT OF MES. VERA E. ADAMS, PRESIDENT, NATIONAL
COMMITTEE AGAINST FLOURIDATION, INC., FORMERLY CITI-
ZENS COMMITTEE ON FLUORIDATION, INC., WASHINGTON, D. C.
The CiiAiRjMAX. The next witness is Mrs. Vera E. Adams. Mrs.
Adams is president of the National Committee Against Fluoridation,
"Washington, formerly Citizens Committee on Fluoridation. Mrs.
Adams.
Mrs. Adams. Mr. Chairman, we grew so much we had to change
our name to fit our functions.
Mr. Chairman, I have cut my statement and then cut it some more,
so that it looks like a game of hopscotch now, but I will try to make it
as brief as possible to bring out what I feel I want to bring out
especially.
The Chairman. Well, Mrs. Adams, your statement will be made a
part of the record in full and, of course, you will observe the limita-
152 FLUORIDATION OF WATER
tion as to time, and the clerk will call attention to the time when it has
expired.
Mrs. Adams. The time has come when the people of this country—
a Nation whose very cornerstone is the integrity and liberty of the
individual citizen — seems to be faced with the necessity of defending
themselves from their own Government in order to preserve that indi-
vidual liberty. They are forced to defend themselves against a pro-
gram of mass medication federally instituted, promoted, and
financed — the program of fluoridation of our Nation's water supplies.
And we who are thus trying to defend ourselves are even being
accused of some sort of mercenary motives in our opposition to this
compulsory doctoring. We are being asked "Who is furnishing all
the money for this campaign against fluoridation?" I will tell you
who is furnishing the money. It is just plain, ordinary citizens who
are jealous enough of their inheritance of liberty to man the watch-
towers, spot danger, and give warning, and the money used in this
cause comes out of the pockets of these ordinary, wage-earning citi-
zens. Unfortunately, the sum at their disposal is infinitesimally small
compared to the millions which are being poured by the Government
into its channels of propaganda.
This committee, which has recently changed its title to National
Committee Against Fluoridation, Inc., was organized in May 1952,
and made an effort through an appeal to our District Connnissioners
to obtain at least a delay in introduction of the process here until the
totally uninformed residents could learn something of the pros and
cons of the subject.
This formal appeal has never been honored with so much as an
acknowledgement. And in direct contradiction of the much-empha-
sized assertion that each city, town, and community must decide this
question for itself, the voiceless and voteless taxpayers of the District
of Columbia have been absolutely ignored, and were simply assigned
the role of guinea pigs in a test case.
As now re])resenting a constantly growing national opposition to
fluoridation of drinking water, this committee strongly urges that
H. R. 2341. a bill to protect tlie public health from the dangers of
fluoridation of Avater, be approved by the Congi'ess. We- urge this
on the following grounds :
(1) We believe that fluoridation is unconstitutional.
(2) We believe that fluoridation is illegal.
(3) We are convinced that fluoridation is ethically immoral.
IS FLUORIDATION OF PUBLIC W^\TER SUPPLIES CONSTITUTIONAL?
The Constitution — the document itself — as written and preserved
in our national archives with an almost sacred care, may be compared
to the steel structural framework of a building. It is the architectural
foundation and skeleton of a living, human edifice planned by the
pioneers of liberty in a new country, whose first timid gropings to-
ward self-government under freedom were inspired by an inborn
spiritual instinct which is the heritage of every man, and a faint
])rophecy of the "glorious liberty of the children of God" referred
to in the Scriptures (Romans 8:21).
FLUORIDATION OF WATER 153
This is sonietliina which is utterly intano:ihle, but indestructible,
and which no amount of unjust domination or even enslavement can
completely crush or kill. It is this spirit of our Constituticm which
is, or should be, the real o-overning i)rinci])le in our free land, and if
this spirit is not cherished and j)reserved, the letter will prove to be an
inadequate safeouard. In many ways we seem to be gettin<;- further
and further away from this spirit, and the lofty principles embodied
in it.
As one of our keen ncAvswriters has said:
Most Americans can see that Soviet tyrannies in Eastern Germany and else-
where menace their own freedom. But fewer can see that growing disreirard
of principles of human dignity embodied in the American ix)litical heritage
is a darkening cl(»u(l on the Republic's horizon.
In ao-reement v.itli this is a statement by Judfre Elias F. Shamon,
special justice of Boston Muncipial Court, which appeared in the
Boston Sunday Post of April 4, 1954 :
Some of our hiiih court judges are injecting into their decisions a wave of
secularistic thinking which is as insidious as the Communist menace. * * *
There are statements in these decisions which declare that all concepts are
relative — including truth and morality — and nothing is absolute. * * * The
thought that all concepts are relative affects us deeper than the mere logic in-
volved. Our Government is based on the assumption that there are certain
absolute concepts, referred to in the Declaration of Independence as the "laws
of nature and of nature's God." The concept of God is certainly not a relative
one. The concept of truth is certainly not relative, and to say that man is en-
dowed on birth by his Creator with certain inalienable rights is certainly not a
relative conceiit. * * * It is totalitarianism to hold that morality and customs
are changeable as the times, becaiise if we siibscribe to this doctrine, we mvast
6ay that the will of the majority makes right and what was true yesterday
may not be true tomorrow — it all depends upon who is in power. * * * It
means that the state — the sovereign — can look over a r)erson"s home, decide
to take it without benefit of eminent-domain proceedings and tell the owner
that his rights of property are subordinate to the will of the sovereign.
As an example of such an insidious decision is that rather recently
ofiven out by a Jiulcfe Artl in Cleveland, Ohio, who, in tryino; to prove
fluoridation justified, said:
A person's constitutional right to treat bis health as he deems best, and of
parents to raise tht^ir children as they deem best, and to be free from medical
experimentation and to exercise freedom of religion are all subordinated to the
common good.
He leaves with us the implication that the "common "rood"' is to be
determined and defined solely by the state. In the case of fluorine
in drinking water, it is the state (alias the Public Health Service)
which is decreeing what is for the "'common good." One more step,
and the state owns the child, and the individual, even as in Russia.
We l)elieve that the first amendment to the Constitution is vio-
lated b\' this program of compulsory mass medication and mass
l^rescription. As Dr. Paul Manning has said in his Case Against
Fluoriclation :
Fluoridation of the public water suivply violates the fundamental principle
of human rights and dignity — the principle that no person or agency shall have
authority over the body of a human being other than himself.
Some of our legislators, in State and city, are assuming powers
which they do not actually and rightfully possess. It is evident that
neither the State nor the Federal Government has any possessive
right over the body, or mind, of the individual citizen just so long
154 FLUORIDATION OF WATER
as that citizen is doiiio- nothing which miglit endanger the health and
well being of other citizens, and so long as there is no emergency
which would require the application of special measures.
Will any reasonable person attempt to claim that tooth decay is a
national emergency, an epidemic, or even a contagious disease? Let
the authorities, under the direct inspiration of the Public Health
Service, are seeking to apply emergency tactics and police power
to combat it.
Dr. Gordon Leitch, chairman of the public policy committee,
Oregon State Medical Society, in the medical journal, Northwest
Medicine, for March of this year, referring to the fallacious state-
ment that fluoridation is basically to dental caries as chlorination is
to the enteric diseases, such as typhoid fever, has this to say:
It is here the plausible comparison breaks down, and the efforts of public-
health officials begin to take on a different hue. When they step from the
bounds of communicable and contagious disease, they step out of their legiti-
mate, well-recognized field, into the I'ealm of medical thex-apy, whether pre-
ventive or curative, where the rights of individuals are of paramount importance
and far transcend the interest of the public. Police power of the state, from
which stems public-health authority, has no place in the prevention or treatment
of a disease which harms only the victim thereof.
In the Hastings Law Journal, volume IH, spring issue 1952, in
an article Comments — Fluoridation of Public Water Supplies, by
James B. Thompson, we have the following :
Pound, in Interests of Personality (28 Harvard Law Review 343, 349, 355,
1915), classified this inalienable right of the individual as "interests of per-
sonality— the individual and spiritual existence." He divides the interests in
the physical person into five categories : "Immunity of the body from direct
or indirect injury ; preservation and furtherance of bodily health and immunity
of the will from coercion ; freedom of choice and judgment as to what one will
do." These three have long been recognized. The other two are products of
the progress of civilization, namely : "Immunity of the mind and nervous system
from direct or indirect injury, and the preservation and futherance of mental
health ; and freedom from annoyance which interferes with mental poise and
comfort." * * * These interests, within limits, shall be recognized legally and
given effect through the force of the state. It would seem that if it was up
to the state to give force and effect to these rights, it should not be allowed to
invade them itself. Such seems to be the case with fluoridation.
In the case of TomUnson v. Armour <& Co. (75 N. J. L. 748, 70
Atl. 311, 317) , the court said :
Among the most fundamental of personal rights, without which man could
not live in a state of society, is the right of personal security, including the
"preservation of a man's health from such practices as may prejudice or annoy
it." (Blackstone's Comm. vol. 1, 129-134)- — a right recognized, needless to say,
in almost the first words of our written constitution (constitution of New
Jersey, art. 1, p. 1).
In spite of the fact that this can be proved to be a federally con-
ceived, promoted and financed program, we are often told that it
is not a Government matter — that each local community must decide
for itself, by referendum or vote — whether fluoridation should be
adopted or not. We assert that no referendum, or even vote, is com-
petent to define or decide the constitutional rights of each individual
in a community. One person may heartily endorse a medicine, but
regardless of his faith in it or belief in its efficacy, of how much he
may want to recommend it to his neighbor, he does not have any
right, or police power, to force that neighbor to take it, either by
persuasion, by a voting machine, or by force. The moment he at-
FLUORIDATION OF WATER 155
tempts to do this, he is infringing upon thiit neighbor's inalienable
rights conferred by the Declaration of Independence and the Consti-
tution.
The doctrine that "might makes right, and truth is a majority
vote," is a dangerous one. In the matter of fluoridation of the
drinking water, wliich is an indispensable article of diet, and neces-
sary to life itself, no authority, local, State, or Federal, has any
right to tell people, '"You're going to have fluorine in your water
whetlier you like it or not."
There should always be some individuals opposed to fluoridation
even in places where a majority might ignorantly vote for it. A
vote for fluoridation is always based on insufficient information on
both sides of the question, and so cannot re[)resent an intelligent
and considered judgment. And our citizens cannot hope to get
information on both sides of this question from the proponents, as
from their standpoint there is only one side.
If there is only one side to this question, why is it that close to 400
cities, towns, and communities have rejected fluoridation of their
water supplies in one way or another, some after several years of
trial, and some after it has been sneaked in on them secretly, but
later exposed. These represent roughtly about 30 million of our
po])ulation, surel}^ a cross-section too large to be ignored.
The Hastings Law Journal above referred to further states that —
tlie first amendment to the Constitution provides that Congress "shall make no
law prohibiting the free exercise of religion." The 14th amendment protects
citizens or respective States similarly. In Cnvtu-cU v. Connecticut, the court
reasoned that freedom of religion is guaranteed by the 1st amendment and
is protected l>y the 14th amendment from State interference. The Court
there reasoned that freedom of religion has a duel aspect : freedom to believe,
and freedom to act exercising sucli lielief. The test is the weighing of the
interest of the State against the right of the individual to exercise religious
beliefs.
r>efore the interest of the State will outweigh the interest of the individual,
there must be a showing tliat the exercise of the particular religious belief is
of such a nature as to create a "clear and present danger," that it will bring
about substantial evils that the State has the right to prevent. Dental caries
creates no epidemic or emergency of contagious nature. Therefore, we have
no "clear and present danger" or any evil at all. There is a failure to rebut
the presumption of unconstitutionality. Consequently, it must stand that fluor-
idation of public water is unconstitutional because in violation of freedom of
religion. * * * Fluoridation of water is, therefore, in violation of State laws and
the Federal Constitution. The more serious constitutional objections must
be hurdled before a State validly may introduce fluoride into public water
supplies.
A majority opinion handed down by the Supreme Court in 1943
contained the following significant statement :
If there is a sixth star in our constitutional constellation, it is that no oflicial,
high or petty, can prescribe what shall be orthodox in politics, nationalism, re-
ligion, or other matters of opinion, or force citizens to confess by word or act
their faith therein. If there are any circumstances which permit an exception,
they do not occur to us.
But wlien the people of this country, up to the number of approxi-
mately 30 million, resist compulsory mass prescription and medication,
which represents direct and deliberate interference with their per-
sonal and bodily self-government, what happens? They are called
names — all kinds of names — "crackpots, know-nothings," and worse.
48391—54 11
156 FLUORIDATION OF WATER
More than this, they are even the object of personal threats and insults.
President Eisenhower, in his talk before the American Newspaper
Publishers Association, said:
If the day comes when personal conflicts are more significant tlian honest debate
on great policy, then the flame of freedom will flicker low indeed.
We cannot get the proponents of fluoridation to enter an honest
and open debate ; they will talk only when they have the whole stage
to themselves, and they always fix it so that they have the last word.
The real reason is that they cannot give satisfying answers to the
arguments so generally and logically being advanced against mass
experimentation on whole populations with an admittedly unproved
and possibly dangerous element.
In the very recent decision of the Supreme Court in the District
school segregation case, there is the following very pertinent passage,
which is directly applicable to this present case of fluoridation:
Although the Court has not assumed to define "liberty" with any great pre-
cision, that term is not confined to mere freedom from bodily restraint. Liberty
under law extends to the full range of conduct which the individual is free to
pursue, and it cannot be restricted except for a proper governmental objective.
We ask. Are the people of this country free to pursue the full range
of conduct which they may choose in regard to employing the method
of treatment which they desire when they have actually poured down
their throats a dosage of fluorine impregnated water which they do
not want, and do not need ? Is this liberty under law ?
IS FLUORIDATION OF PUBLIC WATER SUPPLIES LEGAL?
In January of this year, District Court Judge James U. Galloway,
of Shreveport, La., issued an injunction halting that city's move to
put fluorine into the drinking water, from which the following is
quoted :
* * * medication, in lay understanding, includes prophylaxis or preventive
measures, when applied to the individual * * * Considering the end results
that are sought, we cannot escape the conclusion that it is a form of medication,
or at least a scientific treatment or a sort of hydrotherapy, by way of ingesting
these mineralized waters, of and for the children of the community under 12
years of age * * * No person or segment of the population having that condi-
tion (dental caries or tooth decay) can on that account have any adverse effect
on the health, dental or otherwise, of the general public or of any segment
thereof. We repeat, in our opinion this is not a matter of public health. It is
strictly within the realm of individual and personal dental health and hygiene,
within which each person should be free to choose his course for himself and those
for whom he is responsible in the family relation. To this field, the just powers
of the Government do not extend.
In an Associated Press dispatch of September 14, 1952, President
Eisenhower was quoted as saying :
I am opposed to a federally operated and controlled system of medical care
which is what the administration's compulsory health-insurance scheme is, in
fact. It would destroy things that are essential to high-grade medical service.
For instance, we must preserve the completely voluntary relationship between
doctor and patient. This means that there must be no intermediary — and that
is what the Government becomes if the doctors get paid, not by the patient, but
by the Government. But still more important is the effect of compulsory methods
on the patients. * * * The patient may fear — and no doubt correctly in many
cases— that he would receive regimented, assembly-line treatment instead of care
that is tailored to his individual needs.
FLUORIDATION OF WATER 157
Now, bearing in mind the almost limitless variation of individual
phyLiical disposition and susceptibility, how about dosing our drinking
water, every drop of it available, with a fixed percentage of a highly
toxic chemical such as fluorine and made the dosage uniform and gen-
eral, regardless of the amount consumed, amount of fluorine taken in
from other sources, such as food, state of individual health, allergies,
and so forth? Is this not assembly-line treatment at its worst? Is
this "preserving the completely voluntary relationship between doctor
and patient" which is so essential? Is not the Public Health Service
an intruding intermediary here ?
We may here point out that no local departments of health, or even
local dental societies, have ever considered fluoridation sufficiently
essential to the public health to take the initiative in ordering, or even
advising, its adoption ; the inspiration and motive power have come
solely and directly from the Federal Public Health Service.
In this connection, we may point out that this is only the beginning
of this regimented, assembly-line treatment. Dr. Gordon Leitch, of
the Oregon State Medical Society, stated in the medical journal
Northwest Medicine for March 1954 :
* * * Considerable interesting information on the medication of community
water supplies, of which the addition of sodium fluoride is but the current or
initial possibility, has come to light since this question was first viewed. If
American medicine would do the public a service it should recall immediately
any and all endorsements pertinent to fluoridation and its hidden appendages
which have been extracted from it. Then it should restudy the entire problem
in all its ramifications and implications in the light of the evidence now
available.
And in an article entitled "A Year of Decision," in the same maga-
zine for January 1954, Dr. Leitch says :
While for the moment the proposal rests with fluoridation, if the theory la
sound it is just as logical to add salicylates or cortisone to combat headaches
or arthritis, or to add chlorophyll to ward off body odors. Indeed, the day might
logically be anticipated when the pipelines of a city will be so laden with medi-
cations deemed necessary by public health authorities bent on serving the masses
that the medicated fluid will need intermediate booster pumping stations to see
that it reaches its destiuees, at which time the medicated fluid will be good for
caries, dandruff, and falling arches ; but we hate to think what it would be like
when mixed with bourbon.
In the Consumers' Research Bulletin of last March is the following
quotation from the Medical Press, a well-known British journal for
physicians :
Unless the medical profession takes a firm stand, expediency will continue to
triumph over caution and commonsense, and we may well be faced with irrever-
sible results. * * * It is more than time for our present lethargy and inertia
were replaced by an alert and suspicious vigilance and that all proposed and
existing food additives were subjected to the sharpest scrutiny * * * else we
may well spend the next generation in medicine trying to unscramble —
the harm that has been done to the human organism by prevalent fac-
tory practices in preservation, processing, and sophistication of foods.
Water, of course, being an indispensable article of diet, and essential
for life, must be classed as a food.
Dr. V. O. Hurme, of the Forsyth Dental Infirmary for Children,
Boston, Mass., in a letter dated October 22, 1953, to a correspondent,
has this to say :
The proponents, as well as the opponents, of fluoridation generally overlook
the fact that it is incumbent upon the proponents to prove, beyond all contention,
158 FLUORIDATION OF WATER
that fluoridation is safe and desirable for 100,000 people out of 100,000 people.
It is not necessary for the opponents to offer this proof, since they are not pro-
posing to dose everyone in a community with a minute daily dose of a toxic
*,*hemical, for which there is no known antidote.
The United States Supreme Court ruled in 1914 that it is incumbent upon the
person who places poison in a food to prf»ve that it is not toxic; the burden is
not upon the complainant to establish that fact.
And further :
I can assure you of the fact that the generally accepted principle of biologic
variation is being ignored completely by the dental and medical groups which
are sponsoring fluoride treatment of public water supplies. * * * The very
nature of the fluoride problem calls for well-integrated medical research pro-
grams, which may require at least 20 years to produce meaningful results. The
insidiously cumulative effects of this halogen do not permit the making of hasty
conclusions, if we aim to remain unemotionally scientific.
But now after only a few years of experimenting, and on the basis
of conchisions arrived at by what they themselves call association,
i. e., variable, relative, and essentiall}" unscientific evidence, they are
ready to go full steam ahead on the calculated risk streamlined special,
full throttle and no stops scheduled, and let anyone who gets in the
way beAvare.
Cincinnati is a glaring example of how they are working. A year
ago in February they had all the machinery set up and the date an-
nounced for turning the valve, when a courageous radio commentator,
by the name of Tom McCarthy (no relation) threw a monkey wrench
into the whole works by revealing that there were actually two sides
to this question, strange as it might seem, instead of just only one.
The battle raged for 10 months, with Mr, McCarthy being threat-
ened and intimidated, and even jDut olf the air once, but restored by
popular demand, until in November of last year the people got the
vote for which they had petitioned in unprecedented numbers, and
stopped the program short by a large majority.
Dr. Robert J. Mick, author of Large Facts That Are Kept in Small
Print Relative to Fluoridation, says :
I believe fluoridation of water is worse than an atomic bomb. Those injured
by the atom bomb may get over their illness but those born with injuries caused
by consumption of artificially fluoridated water will never get over the ill
effects.
He declared the absolute true ill effects of artificially fluoridated
water cannot be told for at least two generations, at which time it will
be too late. Through research in conducing rat experiments into the
lliird generation, use of fluoride developed cripples and paralysis of
rats.
I believe the American Dental Association, of which I am a member, and any
<>ther organization which has endorsed artificial fluoridation, will contribute
to the greatest harm ever to befall the unborn children of the IJnited States.
Our good neighbor, Canada, is having to fight the sale of this made-
in- America product. In Saskatchewan and Alberta Provinces con-
troversy is raging over the introduction of fluoridation. Mrs. C. R.
Wood, member of the legislature from Stony Point, in Alberta, de-
clared recently that it is "contrary to the right of each individual to
choose what he or she shall take into their bodies by way of drugs or
chemicals * * * and savors of totalitarianism.'' So strenuous has
been the opposition that final plans for treating the water in both
FLUORIDATION OF WATER 159
Regina and Saskatoon, two of the larg:est cities, have been postponed
because of heavy signing of petitions for a vote. The people of Sas-
katoon so resented what they term ''forcing Ihioridation down cur
throats without our permission" that everything there also is being
held up.
We may well ask, Why all this opposition? Because tiuondation
of drinking water is essentially an illegal procedure, and hurts people
in tlieir most vulnerable point — their instinctive love of their rightful
individual freedoui. It represents an assumption of authority on the
part of a department of the Federal Government which is not real, and
a brazen presumption of knowledge and wisdom which does not exist.
And Avhat about the Federal Food and Drug Act, which is designed,
l)resumably, to protect the health and lives of the people of this coun-
try ? This act declared that it is unlawful to place a nonnutritive or
deleterious substance in food or drink and imposes a fine of $5,000 or
imprisonment or both. The famous Beer case in Massachusetts is a
case in point. An indictment was returned March 7, 1945, against the
Commonwealth Brewing Corp. and Leo Kaufman, treasurer and
manager, Springfield, Mass.
The violation of the pure food laws charged was: Adulteration, sec-
tion 402 (a) (2), the product contained an added poisonous or dele-
terious substance which was unsafe within the meaning of the law
since it was not required in the production of the product and could
have been avoided by good manufacturing practice.
In that case the District Court Judge Ford ruled :
The question is. Is flnorine itself deleterious? * * * i want to point out
to you that it is entirely unimportant and irrelevant how much the qujantity of
fluorine was which was added to the heer. The issue is, Was fluorine in some
form added as an ingredient? * * *It is an added deleterious ingredient the
statute denounces, not an added quantity of the deleterious ingredient. * * *
I want to make this plain — that the quantity of fluorine added to the beer has
no relevancy here. I think I miuht point out to you that there is a section of the
Food iind J)rug Ast wl'ere the quantity contained in a food may be of considerable
importance, and that is where it has lieen charged under section 402 (a) (1) of
the statute which deals with adulterated foods where the deleterious substance
has not been added * * *. Congress recognized that nature's products such
as grain, salt, hop.s, water, contain poisonous substances in small amounts and
that they were not a danger or evil so long as the poisonouis substance was not
extracted by artificial process and added * * *. in the case of an added ingre-
dient, quant'ty is irrelevant, and the only question involved where it is added is,
Was it added? Was it deleterious? Was it unsafe?
And now we see a strange procedure, and one which should be
clearly explained. In July 1952, shortly after fluoridation was forced
on the citizens of this city, this same Food and Drug Administration
which made (lie laws on the citizens of this city, this some Food and
Drug Administration which made the laws on the basis of which this
Beer case was judged, gave out the following sudden statement of
policy :
The Federal Security Agency will regard water supplies containing fluorine,
within the limitations recommended by the Public Health Service, as not action-
able under the Federal Food, Drug and Cosmetic Act. Similarly, connnercially
prepared foods within the jurisdiction of the act, in which a fluoridated water
supply has been u.^ed in the processing operation, will not be i-e'4arded as action-
able under the Federal law becanse of the tluorine content of the water so used,
unless the process involves a significant concentration of fluorine from the water.
In the latter instance the facts with respect to the particular case will be
controlling.
160 FLUORIDATION OF WATER
Pertinent to this specific exemption of an illegal practice is a
comment by Mr. G. S. Bratton, of the Anheuser-Busch Co. in St.
Louis, who represents an unanswerable argument against fluorine in
public water supplies. He says:
There is a very litle actual long-term experience with fluoridated water in the
large industrial cities.
He states that wet-corn millers in the Kansas City and St. Louis
area use tremendous quantities of water in processing 20 million
bushels of corn annually, and they do not feel cheerful over the
prospects of fluorine in the water. Mr. Bratton further says :
Malt-syrup manufacturers are just as unhappy over their fate, since malt
syrup made with fluoridated water may contain up to 8 parts per million of
fluorine.
This is far above the margin of safety so confidently defended by
the propagandists for fluoridated water. Also in the production of
baker's yeast, it is not known what effect the addition of fluorine may
have on yeast culture, but it is known that sodium silocofluoride is
more toxic to yeast than sodium fluoride.
But our food and drug authorities have now fixed it so that the
propagandists for fluoridation have the green light — a sort of courtesy
card or personal privilege to break the law, and only what they call
a significant concentration of fluorine, which might mean death, would
attract notice, and then not in time to save a victim. Only an autopsy
would prove that an actionable amount of fluorine had been present
in the water or food which killed someone who had every right to be
protected by his Government.
In view of the above facts, we ask you to judge whether this practice
can be defended as being legal.
FLUORIDATION OF PUBLIC WATER SUPPLIES IS ETHICALLY IMMORAL
We have just recently listened to an amazing statement. This
statement was to the effect that the Public Health Service is not
pressing the fluoridation program. Ask the nearly 400 cities and
towns which have waged war to win their freedom from pressure
for fluoridation what they think about such a statement. They know
very well where the pressure is coming from. Any one who has had
even a glimpse of the report of the Fourth Annual Conference of State
Dental Directors with the Public Health Service and the Children's
Bureau, held here in June 1951, would have to laugh at this state-
ment. That report has already been brought to your attention by
our Mr. Palmer. It is one of the most revealing documents ever to
come from a Government agency, and is a story of intensive propa-
ganda for mass medication. It was not, of course, ever intended for
general public consumption.
Mr. Robert L. Kern, editor of the News-Democrat, Belleville, 111.,
says:
Whether or not it realizes the truth, the United States Public Health Service
now has gone overboard to promote a scheme that conceivably might turn out
to be an instrument of race suicide.
The Public Health Service is putting out a tremendous amount
of propaganda material for the promotion of fluoridation throughout
FLUORIDATION OF WATER / 161
the country. While they admit that fluoridation is an experiment —
that they don't know the answers— and have to admit that the time
period for such a vital experiment has not nearly been fulfilled, their
promotion material gives no hint of any uncertainty, but presents
the supposed good effects of this medication as proved and conclusive.
Their high pressure salesmanship instructions on "How To Obtain
Fluoridation for Your Community" contains a long list of "do's and
"don'ts" to guide the promoters.
Those who for good and conclusive reasons oppose fluoridation
are dubbed "obscure scientists" or "self-appointed protectors of the
public," and are supposed to get their information from "out-of-date
and unrecognized medical dictionaries and encyclopedias." I wonder
if they would put Thorpe's Dictionary of Applied Chemistry in this
class. In volume V of that dictionary, under the discussion of fluorine,
we find this :
Both fluorides and fluosilicates are toxic and dironie poisoning may result
from the presence of fluorides in drinking water * * * The use of silicofluorides
for food preservation is illegal * * * Sodium fluoride is very poisonous, as
little as 1 gram constituting a fatal dose.
Now chronic poisoning results only from the long continued inges-
tion of minute doses of a poison, and that is precisely the danger -^s^ith
fluorine. This same promotion booklet goes on to say :
Do not refer to fluoridation as "therapeutic," "medicative," artificial,"
"experimental."
Do not refer to fluoridation as "treatment of water," "mass medication," or
"mass treatment."
But in spite of the cautious do not's it is all of these things.
It was Oscar Ewing who inaugurated the present intensive cam-
paign to fluoridate the water not only of this country, but apparently
of the world, if possible, as a supposed health measure. His yearly
budgets are said to have been considerably over a billion dollars and
during the years of his administration, in addition to huge sums spent
for high-priced propagandists, for other personnel assigned to this
project, and for advertising and propaganda material, some hundreds
of millions of Federal tax money, as subsidies, were poured out to
State and local health boards on condition that under detailed in-
structions they would push this health program.
From all over the country I have been getting letters now for 2
years past, increasing in volume lately, all in the same tone — "They are
trying to force fluoridation on us here, and we want to know how to
fight it." One received on May '?> from a doctor in a little town in
Wisconsin — Delavan — says :
Fluoridation of the public-water system was started here some 8 or 4 years ago
by State and local sponsoring pressure groups. It was connected up and put in
actual use in the early fall of 1953. This was an arbitrary transaction without
the benefit of referendum until some 6 months later at the April election.
Those opposing fluoridation were denied access to newspapers which were
attacking all opposition as "crackpots" * * *. Just before election, the Rotary
Club, the PTA, the public school, one church, and neighboring newspapers were
enlisted on the side of the sponsors, including promotional picture shows in the
public library, PTA, the public school, and a church.
At this time I prepared a two-page informative letter and mailed it out to
600 voters 4 days before election. Results : Fluoridation was rejected 1,091 to 755.
On the same day LaCrosse and Waterloo rejected fluoridation about 10 to 1 and
Manitowoc rejected it by a comfortable and gratifying majority * * *. The
vicious attack is still going on. Smear and discredit are the tools employed.
162 FLUORIDATION OF WATER
We submit tliat it is unethical to institute treatment of whole
municipal water supplies with fluorine compound without first gain-
ing the consent of every person so treated. There are quite a number
of cities and towns in this country where fluoridation has been started
without the consent, and sometimes Avithout even the knowledge of
the residents. Some of these are : Anchorage, Alaska ; Louisville, Ky. ;
Salem and Beverly, Mass. ; Saginaw, Mich. ; Charlotte, N. C. ; Pitts-
burgh, Pa. ; Nashville, Tenn. ; and Marshfield, Rhinelander and
Stevens Point in Wisconsin. In Mount Dora, Flu., which voted out
this mass medication by 3 to 1, after it had been in 2 years, the editor
of the Mount Dora Topic cited information from an authoritative
source in Washington to the effect that :
The public can soon expect bills to be introduced into their State legislatures
to make fluoridation compulsoi"y in every community that has a public water
supply * * *. I have seen a release sent out from Washington by the propa-
ganda machine of the proponents of this scheme which states that the only opixj-
sition to water fluoridation in each State is a few scattered "crackpots" who
only write spurious letters to the legislators and newspapers, and they call upon
the legislators to "use common sense and throw those letters into your waste-
baskets."
This mass medication is unethical and immoral because it violates
the fundamental right and privilege of every individual to select the
physician who is to prescribe for him according to his own individual
physical tendencies and condition. No two people are alike in their
requirements of both types and quantities of remedies, and to treat
165 million inhabitants of a country with a mass prescription is there-
fore not only an absurdity, but a moral offense.
In this connection I would like to quote a few passages from an
address delivered on September 14, 1952, under the head of "The
Moral Limits of Medical Research and Treatment," by Pope Pius
XII:
Scientific knowledge has its own value in the domain of medical science no
less than in other scientific domains, such as, for example, physics, chemistry,
cosmology, and psychology. * * * But this does not mean tliat all methods
or any single method, arrived at by scientific antl technical research, offers
every moral guaranty * * *. There are well-defined limits which even medical
science cannot transgress without violating higher moral rules. The confiden-
tial relations between doctor and patient, the personal right of the patient to
the life of his body and soul in its psychic and moral integrity are just some of
the many values superior to scientific interests * * * jjj ^he first place it must
be assumed that, as a private person, the doctor can take no measure or try
no course of action without the consent of the patient. The doctor has no
rights of power over the patient other than those which the latter gives him,
explicitly or implicitly and tacitly. * * * We come back to the question : Can
public authority, on which rests responsibility for the common good, give the
doctor the power to experiment on the individual in the interests of science and
the community in order to discover and try out new methods and procedures
when these experiments transgress the right of the individual to dispose of
himself?
In the interests of the community, can public authority really limit or even
suppress the right of the individual over his body and life, his bodily and psychic
integrity? To forestall an objection, we assume that it is a question of serious
research, of honest efforts to promote the theory and practice of medicine, not
of a maneuver serving as a scientific pretext to mask other ends and achieve
them with impunity. * * * Insofar as the moral justification of the experi-
ments rests on the mandate of public authority, and therefore on the subordina-
tion of the individual of the community, of the individual's welfare to the com-
mon welfare, it is based on an erroneous explanation of this principle.
It must be noted that, in his personal being, man is not finally ordered to use-
fulness to society. On the contrary, the community exists for man. * * * Now
FLUORIDATION OF WATER 163
medical experiments — the subject we are discussing here — immediately and
directly affect the physical being, either of the whole or of the several organs,
of the human organism. But, by virtue of the principle we have cited, public
autliority has no power in this sphere.
It cannot, therefore, pass it on to research workers and doctors. It is from
tlic state, however, that the doctor must receive authorization when he acts
uiKin the organism of the individual in the "interests of the community." For
tlii'ii he does not act as a private individual, but as a mandatory of the public
p Mwer. The latter cannot, however, pass on a right that it does not possess,
save * * * as the legal representative of a minor for as long as he cannot make
his own decisions, of a person of feeble mind, or of a lunatic.
We submit, therefore, that the present program of fluoridation of
drinking water is in violation of the spirit of the Constitution, that
it is consequently illegal, and contrary to ethical morality ; also that
there are unresolved doubts as to the safety of this program, as no
adequate and conclusive experiments have been carried to their logical
end to convince us that there is no possible danger to health to all
types and ages of individuals.
I would like to just mention that I have a copy of a letter put
out by the American Dental Association under date of April 30 of
this year, going to all members, urging them, each one, to write their
Congressman and Senators and urge the opposition to this bill, giving
personal reasons for it, and each member is to write five other dentists,
doctors and dentists, and they are to do the same thing.
And, one significant point is this, one of the points that they are
told to emphasize is that they believe 1 to 2 parts of fluorine in the
drinking water is advisable. Now, we have already gotten up to
two parts instead of one, so there is no accurate gage of the amount
that is to be put into the drinking water.
The Chairmax. Your time has expired.
Mrs, Adams. May I read one other paragraph ?
The Chairmax. If somebody will yield.
INIrs. Adams. I will noi take any more time then. I am sorry.
Mr. Chairman, I have here quite a little volume of petitions.
The Chairmax. You may read a paragraph if you have a special
paragraph you wish to read.
Mrs. Adams. Oh well, probably I might as well stop. I have here
quite a little volume of petitions that have been sent to me from all
over the country, from Sandusky, from Florida, from Ohio, and they
wanted me to hand them in. I do not know whether this is the proper
procedure or not, but they are all signed petitions.
The Chairmax^. Well, of course, they could not be made a part
of the record. That is our usual custom.
For instance in the hearings held last week, I would say that there
were at least 25,000 to 35,000 letters, and petitions, and telegrams
that came in and you can readily see how we cannot give the right
to some to put petitions in the hearings and deny it to others: but
that Vv'ill be made a part of the file in this hearing, and will be given
the attention of the committee when it considers the bill.
Mrs. Adams. They just wanted to know that they were filed as
evidence.
The Chairman. Yes, thev will be filed and will be before the com-
mittee when we give the bill our consideration.
Mrs. Adams. Thank you.
(The paper entitled, "Some Objections to Fluoridation," above
referred to is as follows :)
164 FLUORIDATION OF WATER
Some Objections to Fluokidation
From a letter to Chemical Week, by Vera E. Adams, president, Citizens Com-
mittee on Fluoridation, Washington, D. C, which appeared in condensed form
under the heading "Water Tempest" in their issue of April 4, 1953 :
Many angles seem to be entirely ignored by the proponents of fluoridation,
and one cannot but marvel at the cocksure presumption and self-assurance of
those who are now pounding their propaganda into the public mind with sledge-
hammer insistence. Here are some of those angles :
(1) The unconstitutionality of the mass medication of whole populations,
savoring of totalitarianism.
(2) The total disregard for the factor of individual susceptibility, which any
reputable doctor deems most important, and which demands individual prescrip-
tion and some knowledge of the patient's physical and even mental makeup.
(3) The differing condition of health of individuals, many of whom may have
organic diseases or predispositions toward abnormal physical conditions which
would prevent the proper elimination of fluorine from the body at even an
average rate, which is never complete.
(4) The undetermined amount of natural fluorides consumed in food, as
various foods contain various percentages of fluorine, in addition to any intro-
duced into the water supply.
(5) The impossibility of gaging the amount of water each individual will
drink — 1 person perhaps consuming 5 or G times as much as another.
(6) The effect of atmospheric and weather conditions on the safe percentage
of fluorine to be added to the water supply — such as humidity, excessive heat,
and quick changes in temperature.
(7) The more than 99.5 percent of money wastage represented by the mass
application of fluorine to the total water supply. Only a very small percentage
of water is used for drinking, and a mere 10 percent of the population (children
under 8 years) can possibly benefit up to a hypothetical .50 percent reduction in
tooth decay. It is the hard-earned tax money of the people which is being poured
down the drain in this absurdly costly project, and the people have already regis-
tered their protest and will raise their voices still louder at the coming budget
hearings.
(8) The fact that 1 part per million is above the margin of safety scientifically
arrived at in a study by the University of New Mexico in 1938, which quoted
0.9 parts per million as the danger limit. (See A Study of the Occurrence of
Fluorine in the Drinking Water of New Mexico, and the Menace of Fluorine to
Health, August 1, 1938.)
(9) The report of findings of the House Select Committee on Chemicals in
Food and Cosmetics, which was designed to give the public the results of hearings
held in February and March 1952. and which unanimously counseled caution and
go slow in the introduction of fluorine Into public water supplies pending the
conclusion of long-term experiments planned to show up any possible deletei'ious
effects on the human system.
(10) The known difference between naturally and artificiaaly fluoridated
water, the first containing organic fluorides and the second inorganic fluorides
which the human system cannot assimilate without robbing the body tissues of
other necessary chemicals, or minerals.
(11) The difference between natural calcium-fluoride found in water sources,
and sodium-silico-fluoride, 2,200 pounds of which is being added daily to our
water supply in Washington, D. C.
Note. — A California correspondent writes. "Most people do not know that the
grade of sodium-fluoride which is used in doping the water contains an adulter-
ant which is arsenic."
(At this point someone in the audience asked a question as to the
method of procedure and the method of allottino; time. After informal
discussion the following proceedings were had:)
The Chairman, Well, you have understood, have you not, that the
time is to be divided equally between the proponents and the oppo-
nents, and you have to take that into consideration. That is all I have
to say.
(A further question was raised by a member of the audience in con-
nection with time allotted. After informal discussion the following
proceedings were had:)
FLUORIDATION OF WATER 165
The Chairman. I do not know the point you are making, but you
must agree, I think, that the committee must have the right to deter-
mine for itself what witnesses will be called and in what order they
will be called. While we do appreciate having the assistance of your-
self and others in determining who are to be heard, we must proceed
along those lines.
That is the ruling of the Chair at this time.
The next witness will be Mrs. Peder P. Schmidt. You may proceed,
Mrs. Schmidt.
STATEMENT OF MRS. PEDER P. SCHMIDT, MINNEAPOLIS, MINN.
Mrs. Schmidt. Mr. Chairman and members of the committee:
Point 1 : War on crime, and the destruction of this Nation from
within by insidious w^ays, fluoridation the one here to be discussed, the
most devilish of all ways concocted, the cleverest concealed, so far.
We have now seen a demonstration of how far.
I would like to show you liow long I have known about fluoridation.
That paper was sent to every United States Senator in 1951. I
will read this paragraph here.
I am a native of Denmark, my husband likewise, as a child on my parents' farm
in Jutland, over there, a person worked as a maid, substituting, wliile our regular
girl was back in her own home due to illness in her immediate family. * * *
This person, I learned later, was a man disguised as a woman. * * * This per-
son told me a great deal, to remember as long as I should live, about world con-
quest, enslavement, etc.
This person also carried certain emblems, spoke Danish well, plus
a number of other languages, tried every which way to be allowed
to stay in Denmark, but could not, even tried unsuccessfully to be im-
prisoned.
This person told me what was behind the happenings of the Rus-
sian Revolution in 1905, and that, that same year, from behind, in
the new land America, was organized the Rotarian movement, in a
way to know what was going on in business around the world — much
else — which up until today all have panned out as outlined then in
1909, December, January 1910 — so since as an average person have
followed politics with interest from the ground up and around the
world, especially pertaining to real health, which politicians always
leave out of the picture completely.
Yesterday Congressman Wier whose district I live in tried to bar
me from testifying. I come from Minneapolis. I am in the 17th
month here working on this issue. While Wier did not want to intro-
duce this bill, but I would not go back to Minneapolis and tell them
the reasons that he gave. I just wanted a straight answer "Yes" or
"No." So then he changed his mind and introduced a bill, but has
continually worked against me ever since, and you saw the efforts
here yesterday to put me out of testifying on this, by putting it under
this district.
The Chairman. Mrs. Schmidt.
Mrs. Schmidt. Yes.
The Chairman. There has been nothing said or done by Mr. Wier
that would justify the criticism that you have just made, so far as this
committee has any knowledge.
Mrs. Schmidt. All right. Thank you. I am just referring to Miss
Adams' statement. I would like to make a few comments.
166 FLUORIDATION OF WATER
Grand Rapids, Mich., was represented here yesterday morning. In
connection with Grand Rapids, Mich. :
Reports a felony a day. F. C. Bates, Michigan State Supervisor of Probation,
stated "The volume of criminal work from this court alone is as much as the
total criminal work in 10 circuit courts covering 25 counties." The increase in
gross indecency and child-molestation cases is startling.
Fluoridation is supposed to be the weapon that will be used to
take us.
Dr. Nicholas Nyaradi, former Minister of Finance in Hungary's
jDostwar coalition government, an escapee to America states that Com-
rade Zhuchovitsky, Legal Adviser of the Soviet Ministry of Foreign
Trade in the United States, told him of the plan to poison the water
reservoirs of this country.
It has been publicized time and time again. We are very close. It
is coming very close to home. You do not have to worry about the
atomic bomb. They won't be here. They will be taken over, the water
reservoirs.
I have in my home copies of this American Review of Medicine from
1946 to 1947 and I'm not quoting from this paper.
There are many articles in the American Review on Soviet Medi-
cine, 1943 to 1948. I have the 1946 and 1947 issues in Minnesota.
This says:
Fluorine has been used successfully on patients in institutions for the insane
in order to destroy the will of the inmates.
When the $11 billion lend-lease went to Russia, Major Jordan was
wondering what they were going to use the fluorine for. It was going
into the water of the prison reservoirs and the slave-labor camps.
You hear talk about how wonderful this is for the children. In
Minnesota it is put into the institutions for the aged people.
Also, may I have this bottle with this fluoride? This shows how
much the bath of 30 gallons of water contains. Someone had a little
bottle here. This shows how much it is in the Minnesota State Insti-
tution for the Aged. They built an $80,000 swimming pool. If those
people were not insane, they certainly would be at the age of 70 and
80, with that put into the swimming pool. But here is the amount of
fluoride in just 30 gallons of water that can be absorbed by the body.
That has been proved and verifled. Besides that, the nurses there
told me that they are also using tablets of fluoride to put in the water,
and for internal baths.
I would like to file this paper here for the record. This is from
Mr. , who has a lecture at Atlanta, and so he could not
be here. This is from Minnesota, and you heard reference to it, and
I hope that you gentlemen will see those particular things. I have
asked in my statement, which you will see, that this be turned over —
whatever you decide on it — this be decided on, and after you have
been furnished with it, that it be turned over to the Un-American
Activities Committee of the congressional committee to be further
investigated.
I brought this to the attention of the proper authorities. And here,
I would like for the record to file this, this receipt, to show that it has
been turned over to the proper authorities. And here is a telegram
from Minnesota people asking that there be a rider attached for a
fine and a penalty, to prosecute the violators.
FLUORIDATION OF WATER 167
We were told here yesterday that the people had freedom in decid-
ing on this. It was put into the city of St. Paul without the citizens
knowing about it. For 2 years they fought it, and then a group of
young dentists said that they were going to throw out the old fuddy-
duddies and put in new men, young men as aldermen, and then they
would put that fluoridation in. That happened.
The Governor of Minnesota's office told me that there was nothing
the Governor could do about it, that public health was above the
Governor of the State.
On the 9th of INIarch last year I was processed for 2 hours by the
Secret Service of the Wliite House and told then that nothing so in-
significant as American public health could the President be bothered
about.
I am asking this committee if our Governor can do nothing; if our
President can do nothing; if John B. Knutson, who is the head of this
situation of public health, stated to me — and you will find the quo-
tation in my paper — that this fluoridation program was all right. "I
am going to go ahead with it." And said there was nothing Mrs.
Hobbv can do about it.
When I took it up with Dr. Martha Eliot, of the Children's Bu-
reau, she stated that she had the power and the right, and she was
going to enforce this power and that right to force this on every
American whether they wanted it or not.
I ask you gentlemen, Is that America?
I would like to file these clippings.
I have asked in my statement that fluoride that is bought in drug-
stores should be signed for. Anyone can go in and buy this. It is
odorless, colorless, and tasteless. It has been known in Europe for
the last hundred years. Take a teakettle and boil the stuff in it and
let it accumulate, and give a person some tea from that teakettle, and
they will be gone. Here are fluoride advertisements, as to how you can
go and buy it in any drugstore. Anyone can go in and get it. Y()u
can use it on anyone without asking anybody about it.
No doctor would ever sign a death certificate, where death came
from use of fluoride, because of the fact it is present in your foods.
Here are some clippings from all over the country. Here is the tele-
gram sent to this committee last year asking for an early hearing.
Here is the sample of how the doctors and dentists in Minnesota, in
Hibbing, put this ad in the paper. That is because the chiropractors
there were on the job. Wlierever it has been put down in Minnesota
it has been done by the chiropractors profession, because they have
machines that will show the effects of it, that it is detrimental to the
human system, which the medical profession does not have, the ma-
chines to detect it.
Here are three articles from New York, the New York Post. Then,
in the Washington and in the Minneapolis papers. All of this
flooded. This is the same article. It can be syndicated out over the
United States, but when the people want to, they cannot get in the
papers one thing, when it is voted down. I fought for 3 days with
the editors of the Minneapolis papers to get a part of the election
records put in that had been voted down 2 to 1 in St. Paul; a part of
the election records of November 4, had been voted down 11 to 10 in
Hibbing, Minn., on December 2. Three days later they put it in, but
168 FLUORIDATION OF WATER
they put it in at the bottom of a paragraph, about how 25 cities in
Minnesota had fluoridated and these 2 happened to vote it down. They
never mentioned all of the other places where it had been voted down
in Minnesota.
These are two places where the people got a chance to vote it down.
You spoke of the people getting a chance to vote yesterday. There
is no such thing as getting a vote on it. We don't have that. In
Minneapolis they cannot vote on it. It is not in the city charter that
they have a vote on it.
So, the dentists, and whoever it was behind this, were able to throw
out the aldermen that had protected that city for 18 or more years,
because they would not go along with fluoridation. They put new
ones in. Now, a city of a half a million people is faced with that, and
the Governor can do nothing about it, and your President cannot be
bothered with it, and the public health has the right and the power
to force it in.
We have just one place left and that is you men here, and if we can
depend on you men here as to whether this country goes under, or you
save it, because what happened in this room yesterday, if that is ac-
cepted, that is what has happened to every country, Rumania, Czecho-
slovakia, Poland, before they took over. They didn't use bonmbs.
They went over and took over. The same thing is happening here.
Here, I will file this for the record. This is out of a book by Uncle
Joe, how they are going to produce a brand of humans, like you pro-
duce different vegetables; like you produce different animals, and
stated that it could also be done to men ; that men had to be changed ;
that evolution — man was too slow this way. He had to be changed.
This is from the book by Budu Iwanidsi, My Uncle Joe, and pub-
lished in London in 1952. These are his words :
Natural evolution, which is too slow for the present rhythm of technical prog-
ress. Men must be converted from a terrestrial animal to a solar universal
animal —
and of course if you want to produce something new, you first have to
get rid of the old.
I also have a part of a speech given in Bulgaria. I have parts of
others given in Budapest, prior to February 1952, when they told the
citizens of Budapest, anyone who was not working could get out of the
city. What happened to them we do not know. The rest of the
people were told to get at one end of the city and they took over the
other. Prior to that, 4 weeks in advance, they had given speeches and
in that speech stated positively, stated that in America now was the
last generation of white children being born, and Dr. Betts showed
you in his paper yesterday that the cattle cannot reproduce.
That happened in Germany when Hitler took over.
I am just going to give you this one point and then I will go.
The Chaieman. Mrs. Schmidt, your time has expired. You are 1
minute over now.
Mrs. Schmidt. All right.
The Chairman. But I want you to know that you have the privilege,
and the same is true with reference to the other witnesses, to revise
and extend your remarks, but it will not be possible to include all
of those clippings and articles that you have presented and have on
the desk there this morning.
FLUORIDATION OF WATER 169
Mrs. Schmidt. I would like for these to be left here.
The Chairman. If you value those, I would suggest that you take
them with you.
Mrs. Schmidt. I want to show here is a letter. This was written
from St. Paul, shows how St. Paul was taken over and there was
fluoridation without the citizens knowing anything about it, and they
were never given a chance even to vote on it.
I have asked to leave them here. The gentleman tells me he will
return them to me.
The Chairman. Mr. Clerk, will you make a record and see that
those that are left with the reporter are returned to Mrs. Sclimidt.
They are not to be made a part of the record.
(Mrs. Schmidt's statement above referred to is as follows:)
Statement of Mrs. Peder P. Schmidt, Washington, D. C.
Mr. Chairman, and members of the Committee on Interstate and Foreign
Commerce, regarding public hearing on May 25, 26, and 27, on H. R. 2341, water
fluoridation, 1 am requesting to appear as a witness for said bill, representing
groups of people from more than 25 States opposed to drinking poisoned water.
I will require the full 15 minutes of time allowed to each witness — according
to notice.
Point 1 : War on crime, and the destruction of this Nation from within by
insidious ways, fluoridation the one here to be discussed, the most devilish
of all ways concocted, the cleverest concealed, so far. Who were the insti-
gators? Who brought the idea here from Europe? Could it be the group
brought over here from Europe by Frances Perkins to set up the so-called
social security, or could it be the same group who thought out sending our money
plates to Russia?
Point 2 : FBI records describe the atom-bomb conspiracy as the crime of
the century — a plot from within which took away America's greatest defensive
strength. So well did the Communist sympathizers in the United States Gov-
ernment cover up the tracks of the atomic traitors between 1942 and 1945 that
news of the stolen secrets was not acknowledged publicly until mid-April 1951
(reference: Hon. Fred E. Busbey, Representative from Illinois, National Re-
public, Washington, D. C, June 1951, p. 1). Whoever shielded them can be
doing the same for the fluoridators. I say, fluoridation is the crime of this
millenium, destroying America's human strength.
Point 3 : On December 29, 1951, I had been asked to speak on herbs at the
banquet of the Minnesota State Vegetarian Society in St. Paul. That evening
I asked if I could change the topic to fluoridation of public water, as such
had been proposed in Minneapolis and consequently in due time it could be
expected to be an issue in St. Paul, or elsewhere. During the discussion
period one of the ladies spoke up and said that her brother worked for the
waterworks and he had said that they were installing machines for fluoridation
and it was to be used beginning January 1, 1952. No one else present had heard
anything about it or seen anything in the newspapers regarding it. On checking
the newspapers I found that the public health department and other groups
had requested the city council to put in fluoridation and on these requests they
proceeded to do so. St. Paul citizens had not been consulted at all. On" one
occasion Commissioner Rosen stated to a citizen bluntly and forcefully, "You
are going to get it, whether you want it or not. Exactly the same statement
was made in the mayor's reception room in Minneapolis by Mrs. David Young-
dahl to members of antifluoridation groups. Her husband, one of the most
ardent of fluoride promoters in Minneapolis, on October 31, at a council meeting
there where a vote on it had been stopped at 12 to 12, was sitting on a bench
beside me when Alderman Stakowski and Wolenski came to tell him how sorry
they were not to have been able to do any better for the fluoridation deal.
Prior to Christmas 1952, at a "dental clinic" at the Nicollet Hotel in Minneapolis
it had been stated in newspapers that about 500 dentists from around the States
were expected for the several days' affair. I went there to hand out information
on the fluoride question. When the clinic was ended and all were leaving
the hall, about every fourth person rejected antifluoridation literature, stating
170 FLUORIDATION OF WATER
that they were fluoride salesmen — or salesmen for fluoride-dispensing machinery.
Older dentists received the antifluoridation literature gladly. Many of them
called me aside, telling me how much they "abhorred the stuff" in any form,
that it was most disastrous to have it used for human consumption. They
said that it was a change of diet that was needed to avoid bad teeth. Then
a group of the younger dentists surrounded me, arguing that fluoridation was
good, that "we are going to throw out all the old foddy-doddies — next year —
sitting in Minneapolis City Council and put in young progressive aldermen who
will put fluoridation in." Their predictions came true. In 1953 they were
able to change enough aldermen to now, in 1954, get fluoridation voted in over
the protests of Minneapolis citizens — but not yet installed.
Point 4 : I spent October 6, 1952, in Austin, Minn., talking to people about what
they thought of fluoridation, it having been in their good unchlorinated spring
water for about 3 months. A sports goods businessman from the Twin Cities
who had kept his minnows in Austin had lost all of them, over $200 worth ; they
all died the first week that water was fluoridated in Austin. Out of 25 people
that I talked to, 24 were opposed to fluoridation. Three women told me that
they had been told by their doctors not to use any of the fluoridated water for
human consumption ; it was wrecking their kidneys, plus other effects on them.
Two of them were getting their water for kitchen use from farmers' wells outside
Austin, but did not know what they would do when the sulizero weather was
coming. One of them was the wife of the manager of a theater there ; they got
spring water shipped from Minneapolis with the truck that regularly brought
their films for the theater (Chippewa spi'ing water from Wisconsin). To such
inconvenience must people go in this supposedly convenient age to get water fit
for human consumption — or be poisoned.
Point 5 : On June 12, 1952, I went to St. Cloud to the annual mayors' conven-
tion to talk especially to Mayor Johnson, from Duluth. He stated that he was
doing nothing about the fluoridation issue as long as public-health officials rec-
ommended it — that was good enough for him. I talked to a number of mayors
there and found some who had been approached on the subject and I gave them
informative literature on the danger of fluoridation, but was then told by a gen-
tleman there to kindly leave or I would be arrested as I could not come there to
talk to the mayors in between sessions. I also talked to the mayor from Ely,
Minn., who had just a few days earlier found out how dangerous it was, by look-
ing at the labeling of the sacks in which fluoride came (he noticed the skull and
cross bones on the sacks and that the men handling them had to wear rubber
gloves and used masks equipped with dust filters).
Point 6 : On October 20, 1052, I opposed fluoridation in Annandale, Minn.
Dr. Jordan, public-health official there, was in favor of it. The man accompany-
ing Dr. Jordan tried to bar me from the room as I was not a taxpayer there.
But I was ready for them because my husband and I are owners of Fair Haven
Mill property with land in both Sterns and Wright Counties, Annandale being
located in the latter. I handed out quantities of antifluoridation literature
before and after the meeting (don't think Annandale is fluoridated up to date).
When Dr. Jordan was finished with his presentation, the man presiding stated
"if no o'ojection, we will then proceed with the fluoridation, etc." It was then
that I protested. Dr. Jordan, getting up in rebuttal, stated there was always
one opposing it, one fanatic, etc., nodding toward me, that Mrs. Schmidt could
always be depended on to oppose, that she is wrong, IMilwaukee bad voted it in,
and "there is no danger connected with the use of fluoridation in such small
quantities as 1 point per million to 1.5 per million." (The statement regarding
Milwaukee was an outright lie, as practically all else he said also was not true.)
1 was given no further chance to speak. These are just a few samples of what
has been going on across America the last 3 years.
Point 7: From October 21, 1952, until the last meeting January 13, 1953, I
held protest meetings in the mayor's reception room in Minneapolis every 2
weeks. I had suitcases of material put on display from all over the world in
opposition to fluoridation, plus on one table the material favoring fluoridation
so people could see, read, and examine it. Part of the time, some days from
2 p. m. until 10 p. m., or from 6 to 11 p. m., each time for about 2 hours or so,
there were speakers to clarify the matter further and to answer questions. On
January 13, 1953, I told the group then present that it was no use to think that
we could keep on keeping fluoridation out of Minneapolis, or to do anything
to stop it on State level, that I was going to Washington to get legislation in
on it on Federal level. Tlie group then took up a collection for me which
FLUORIDATION OF WATER 171
covered my fare to Washington as I bad almost bankrupted my family opposing
fluoridation and otber measures in earlier years on bealtb and economic topics,
etc.
Point 8: Have tried up to now to show you the iron-fist type, un-American
way in which this has been forced on the American public. The public's ]jro-
test in 90 percent of the cases have gone unheeded. When brought up, 70 percent
of fluoridation has moved in so swiftly that not until it had been in use for
months, would it come to the attention of someone who knew the danger of it,
or until from its detrimental effects were felt, it became known among the
consumers. About 300 cities either have already thrown out fluoridation, or are
in the processes of stopping it. lUit in such cases has the fluoride been removed
or is it still standing by the waterworks, so that at a given signal it can all be
dumped in at one time by the Quislings. Have been told that the pulflic water
supply does not come under civil defense. To remove the fluoride, and to keep
account of any excessive amount of chloride near water works should be a civil-
defense matter.
Point 9 : When I reached Washington last year the need for legislation against
fluoride had not yet penetrated into Congress — no one would touch it ; no one I
talked to would introduce legislation about it in the Senate. My State Senators
refused to do anything about it. Then I started on the House Members. Con-
gressman Judd, who represents part of Minneapolis, refused to have anything
to do witl) the measure. On January 20 I spent several hours, or thereabouts,
with Congressman Hon. Koy V/ier, who represents my district in Minnesota.
When Mr. Wier started to talk about liow to have the bill drawn up, I said I
would leave it entirely in his hands, that it did not matter too greatly how it
was drawn up, as all that would l)e needed would be to have it declared unlaw-
ful due to its destructiveness. That would not infringe on anyone's freedom
or take something away from the States ; instead it would protect our freedom.
Following this discussion. Congressman Wier then introduced H. R. 2341 on
January 29^ 1953. Would suggest that all should be required to sign for fluoride
as is required for other dangerous poisons bought in drugstores. (Other poisons
can lie detected very easily, but not so with fluoride.)
Point 10 : On April 17, 1953, at YWCA, 17th and K Streets, NW., Washington,
D. C, Dr. IMaguusson, Chairman for Truman's "Factfindings on Healtli," was
the speaker at a luncheon. I asked him if he would explain why no material
with any mentioning of opposing fluoride was not accepted into "Findings."
He immediately answered: "The Commission was for fluoridation". (All, there,
present, can testify to this.) But he thought it would take 20 years to tell any-
thing about what it could do to the human race. I, again, asked, "Does that
.justify making guinea pigs out of every American for the next 20 years'?" He
answered : "The Commission only recommends, they do not make the laws."
When Dr. Magnusson was leaving I had a talk with him ; he then admitted to
me that it would take a generation to tell what this could do, and even what
could follow from it in the next generation, as it definitely did something to
all living animal matter.
Point 11 : In the 15 months spent here, I have covered a big territory on
this subject — have all the subject matter for fluoridation, and find that up to
1951 most was written on the study of organic fluoride, which is naturally in
the water. When talking it over with Dr. John W. Knudson, who is the top
man in charge of the fluoridation idea, his answer to me was: "There is nothing
wrong with fluoridation, and I am going to continue on with the program," add-
ing, gleefully, "and there is nothing Mrs. Hobby can do about it."
In my talks with head of Children's Bureau, Dr. Martha Eliot got further
proof of the iron-fist deal. (The Children's Bureau money is being dissipated
for this junket and stuff.) Dr. Blartha Eliot answered, simultaneously, with
a sweeping gesture of her hand, over all the material I had of authorities on
the danger of it, "All these know nothing, I have the opinions of those who
know" * * *. I finally asked her, "granting you. Dr. Eliot, that you are right,
do you feel that you have the power and the right to force this on every Ameri-
can, every mother and child in this country asainst their will?" Dr. Eliot then
go up from her chair, pounding her fist on the table, stating "I have that power
and I have that right, and I shall continue to enforce that power on that right."
* * * The power and intolerance of the fluoridators are unparalleled in America's
history, and was demonstrated in Cincinnati, when Tom McCarthy, station
WKRC commentator, who had spoken against fluoridation, was taken off the
air. The fact that when fluoridation is voted down it is not mentioned in new.s-
48391—54 12
172 FLUORIDATION OF WATER
papers, but when it is voted in, it gets the headlines, should make us all stop
and think.
The fear for America under this iron rule is troubling me and millions of
others, so am asking this committee that when the fluoride question is settled,
regardless of how you may decide on it that the whole situation be immediately
turned over to the un-American activities congressional committees for fur-
ther study, because fluoride has been used for the destruction of much of the
public of Kurope, and perhaps is as little known to the Europeans as it is to most
Americans. Copies of this will go to the Justice Department as I, last year,
there, requested that this fluoride structure, or situation, be checked under
the new law on security passed in 1953, as no loyalty check has been required
in the Department of Public Health and Welfare as far as I know, or have
been able to find out about it. With this I will close my requests.
Mr. Hale. Mr. Chairman.
The Chairman. Mr. Hale would like to ask you a question, Mrs.
Schmidt.
Mr. Hale. Mrs. Schmidt, suppose there was a small municipality
in my district having a population of say 500 people. Suppose they
voted unanimously that they wanted to fluoridate their water supply.
Would you say that Congress should prevent them from doing so?
Mrs. Schmidt. Sir, the Public Health propagandizes them with
millions of dollars.
Mr. Hale. Will you speak louder please. I do not hear you.
Mrs. Schmidt. The Public Health is propagandizing the United
States with millions of dollars worth of material. The people do
not know Avhat they are getting in the cities. They are not told what
is happening. They are not told how this goes in. This gentleman.
Dr. Brusch told you. They are told about organic fluoride, and
they have no proof.
You have not asked them to bring human beings in here, who have
been subjected to this chemical fluid for 20 years, to speak about it.
Mr. Hale. I think you can answer my question "Yes" or "No."
Mrs. Schmidt. Please restate the question again. You asked me
about 500 people.
Mr. Hale. I said suppose that there were 500 people in a small
municipality, constituting a municipality in my district, and that
they voted unanmously that they wished their water supply fluori-
dated; wish a certain amount of fluorides in their water supply.
Should Congress prohibit that? That is what I want a "yes" or
"no" answer to.
Mrs. ScHMTOT. Doctor
Mr. Hale. Now, you can answer that "Yes" or "No."
Mrs. Schmidt. Dr. Sandler
Mr. Hale. You can answer that "Yes" or "No." I would like to
have a "yes" or "no" answer to that question.
Mrs. Schmidt. Do you realize murder by remote control? That
would be the answer.
Mr. Hale. You can answer the question. You will not answer the
question ?
The Chairman. Do you want an answer to the question?
Mr. Hale. It is all right.
Mrs. Schmidt. After all, the people
Mr. Hale. You have refused to answer my question and I do not
want to hear any more. I have asked you a question and you have
refused to answer it.
FLUORIDATION OF WATER 173
Mrs. Schmidt. Must the truth not be known in the United States
any more? I have stated that if the people knew both sides of the
question and were told the truth, there would be no unanimous request.
The Chairman. Are there any further questions, gentlemen? If
not, we think you, Mrs. Schmidt, for your appearance and the in-
terest you have taken in this matter.
STATEMENT OF K. K. PALUEV, RESEARCH AND DEVELOPMENT
ENGINEER, PITTSFIELD, MASS.
The Chairman. Our next witness will be Mr. Konstantine K.
Paluev, research and development engineer, Pittsfield, Mass. Mr.
Paluev is a fellow of the American Institute of Electrical Engineers.
Mr. Heselton. Mr. Chairman, in view of the treatment that was
given to my colleague, Mr. Pelly, yesterday, I will venture the sugges-
tion, in the hope that the chairman will not be called upon to say any-
thing about me.
I do want to welcome Mr. Paluev here. He is a respected consti-
tuent of mine, lives in Berkshire County, and I want to welcome him
before the committee.
The Chairman. We are very pleased to have you, Mr. Paluev, com-
ing from the home community of our distinguished colleague and
member of the committee, Mr. Heselton, who already has informed the
committee of your outstanding ability. We will be pleased to have
the benefit of your statement.
Mr. Paluev. Mr. Heselton is very kind. Thank you, very much.
I am going to try to stay within the 15 minutes, by chopping up of my
oral statement, and therefore, I apologize for the lack of continuity.
Mr. Chairman, I do not represent any organization. All my activ-
ities in this field are financed by myself. I am not a dentist or a
doctor. By education I am an electromechanical engineer with some
30 years' experience in industrial research and development that has
nothing to do with health. The natural question, therefore, is why
am I here, supporting antifluoridation bill H. E. 2341. I am here
because opinion was expressed at 1953-54 fluoridation hearing of Mas-
sachusetts legislators, that my analysis should be made known na-
tionally.
I am convinced that the evaluation of the effectiveness and the
safety of artificial fluoridation needs help from those who have the
temperamental training for research; people who are not scared by
charts, diagrams, tables, and arithmetical calculations; who, as a
matter of fact, enjoy them, who have the patience to scrutinize them
for hours and days if necessary. The profiuoridation literature ex-
hibits an extraordinary lack of such training, with the result than an
unproven hypothesis with experimental evidence against it, has been
presented to professions connected with health and the Nation as a
scientific fact and a grand success. A calculated risk promoters call
it. The fact is, Mr. Chairman, the risk is badly miscalculated.
This happened, I am convinced, not through an evil intent but
rather temperamental inadequacy with enthusiasm rather than
mathematical scrutiny prevailing. We are now confronted with a
grave national danger. This time, not from a big lie, character-
istic of some isms, but with a big untruth, which already has engulfed
174 FLUORIDATION OF WATER
some 24 million people, without their consent. Through interstate
commerce in foods it threatens the rest of the Nation.
I shall now analyze the data and statements found in published re-
ports on the famous and longest artificial fluoridation experiments, in
Newburgh, N. Y., and Grand Eapids, Mich., and in the paper presented
by Dr. John W. Knutson, Chief, Division of Dental Public Health of
the United States Public Health Service, on January 17, 1952, and
published in the New England Journal of Medicine. This analysis
will demonstrate that the artificial fluoridation hypothesis has either
utterly failed or needs to be experimented with in laboratories for
another 10 years at least, and therefore no public water should be
fluoridated until then, if at all.
I will limit myself now to the analysis of the effect of fluoride on
dental decay. For discussion of possible irreparable evil effect on
health, I respectfully refer you to the other part of my pamphlet on
"artificial fluoridation — layman's dilemma," given to the committee.
Let us first examine the chronology of eruption of so-called perma-
nent teeth shown on the chart. Along the bottom the 7 types of teeth
are enumerated — the molars, the incisors — central and lateral — the
second bicuspids, the first bicuspids, tlie cuspids, and, finally, the sec-
ond molars. As you know, normally we have 4 teeth of each type,
28 altogether. I will not discuss the eighth type, the third molars or
so-called wisdom teeth, because of their transitory nature. The 4
first molars erupt between the ages of 6 and 7 as shown by the solid
black. The next to erupt are the incisors. They appear between 6
and 9, as shown. Then come the bicuspids and cuspids. Finally, the
four second molars which are the hindmost teeth, immediate neigh-
bors of the first molars. Please note that in Newburgh at the age of
12, the end of the experimental observation, on the average, only 1
out of 4 second molars erupted.
If we take children born in 1940, by 1945, the year of beginning of
experimental fluoridation, they were 5 years old with none of the
permanent teeth erupted. By 1950, they were 10 — their first molars
were used for 3 years and the next two types have been used, say 2
3^ears, the remaining 4 types have not yet erupted — altogether, a
negligible experience in comparison with a lifetime. The use of 28
teeth of 7 types for say 60 years or 28 times 60 equal 1,680 teeth-years
is a measure of a lifetime experience to be compared with 3 times 4
plus 2 times 8 equals 28 teeth-years experience with only 3 types up
to 1950 or with one-sixtieth of a lifetime.
Yet the astonishing fact is that on the basis of this negligible and
unsuccessful experience, the American Dental Association gave its
formal endorsement for national use of artificial fluoridation as an
effective and safe method. A little more than a year later, Dr. John
W. Knutson had these encouraging words for the future of children
raised on an artificially fluoridated water:
It is their privilege of having straighter, stronger, better looking teeth than
than their parents have had ; * * * that this protection against dental decay
will carry over to the future generation of adults ; * * * these benefits are
not temporary, they last a lifetime.
Mr. Chairman, as you look at the chart you see that the lifetime of
the children we are talking about will expire about the year 2000 and
Dr. Knutson's optimism is based, according to the chart, on not more
FLUORIDATION OF WATER 175
than 4 or 5 years of experimental study of erupted permanent teeth.
A study which revealed, of all things, that artificial fluoridation in
all probability not only does not prevent but very likely aggravates
dental decay. Yet, Dr. Knutson was so convinced of the social bene-
fits from this measure that in the sauie article he asked his professional
audience, "Why are we quibbling, delaying, pigeon-holing in the face
of exhaustive research and overwhelming proof?"
May I now show you, Mr. Chairman, at least some of the reasons
for disagreeing with that research was exhaustive and the proof over-
whelming :
On this chart I have two tables, both based on the data collected
by Newburgh and Grand Rapids researches by 1952, after Gi/o years
of fluoridation, and what do we find? Table A shows among chil-
dren of 12 years of age, there was a total of 12 teeth of the 3 types most
susceptible to the caries or the bacteriological decay, the only type of
dental decay that fluoride is supposed to prevent. As you know, sir,
pyorrhea is even more devastating than caries.
Before fluoridation, 8 of these 12 teeth or 66 percent of them were
' either decayed, filled, or missing after only 4 years of use. The third
line shows that 6i/^ years of fluoridation didn't help much as 6 or 50
percent were found to be decayed, filled, or missing, but the artificial
luoridation hypothesis, so-called by the researchers themselves,
promised, as the fourth line shows, that less than 3 teeth or 22 percent
3f total will decay or be missing after lifetime, that is, 48 years later,
? by the year 2000.
I Now, let's look at table B of children 10 to 12 years old and find the
■i state of their first molars, the only molars erupted by the age of 12.
As the artificial fluoridation researchers write in their report, the
molars are the principal objective of fluoridation as there are at least
I six times as many molars in dental trouble as the next most trouble-
i some.
The table shows that of the 4 first molars, on the average, 3.2 or 80
percent were decayed, filled, or missing after 41/^ years of use with-
out fluoride. With Qy2 years of fluoridation 2.6 or 65 percent became
defective after 41/2 years use, yet the fluoridation hypothesis promised
that there should not be more than one decayed, filled, or missing
tooth — or, more precisely, statistically, 0.8 of a tooth on the average —
after a lifetime experience, that is, not after 414 years but 60.
j Wouldn't you agree with me. Mr. Chairman, that the promoters'
'prediction was more a matter of fortune telling than scientific diag-
nosis? Yet, their claim that artificial fluoridation will reduce decay
by 65 percent for lifetime has been repeated across the land by hun-
dreds and perhaps thousands of echo men in and out of dental pro-
fession, who preferred to resound what they had heard from high
authority rather than patiently scrutinize the data readily available.
We are witnessing here one more illustration of how a well-organized,
deeply convinced and ill-informed group of people can have a pro-
founcl ill effect on our national life.
The data showed artificial fluoridation even in a worse light than
I so far have presented. Let us examine the .next chart where we
will compare the increase in number of decayed, filled, and missing
teeth with the children's growth. This chart represents conditions
found with and without fluoride by Grand Rapids and Xewburgh
176 FLUORIDATION OF WATER
experimenters. The length of bars correspond to number of defec-
tive teeth per child of corresponding age, red for teeth free of fluoride
and black after 6^/^ years of fluoridation.
The comparison of two sets of bars indicates that in fluoridated
areas, up to the ages of 8 to 9, either the detection of decay was more
difficult or there was a temporary delay in decay. However, the un-
expected increase in the rate of fluoridated decay after the age of 9
shows that most likely by the age 14 or at the most 16, fluoridated
areas will have more decayed teeth than nonfluoridated. Such pos-
sibility is strengthened by the phenomenon peculiar to fluoridated
decay revealed on the chart : The number of decayed, filled or missing
teeth in fluoridated communities doubled every 2 years, that is, chil-
dren of 8 years had on the average 1% decayed, filled, or missing; 2
years later they had twice as many or 3 ; 2 years later, when they were
12, the number of decayed, filled, or missing again doubled and be-
came 6.
By the age of 14, therefore, it is reasonable to expect that they
should have on the average 12 decayed teeth, slightly more than
among children of the same age in communities free of fluoridation.
Unfortunately, the experimental observation of the effect of arti-
ficial fluoridation stops at the age of 12. Unless the experimenters
change their routine they will never learn just how long this phenom-
enon of doubling or compounding decay peculiar to fluoride con-
tinues.
There are among the fluoridation promoters those who believe that
for the fluoride to be effective it must be partaken from prenatal stage
on. Therefore, the discouraging evidence of my charts does not
apply, they say, as in the case of Newburgh and Grand Rapids the
first beneficiar)^ of the measure will be the cliildren born in 1946.
But if so, these children were only 3 years old by 1950 and therefore
had only a few milk and no permanent teeth erupted. In the light
of this alternative hypothesis the endorsement of artificial fluorida-
tion by the American Dental Association in 1950 and by the Federal
Government thereabouts had no experimental basis at all and there-
fore is still more astonishing.
They should have waited until these children reached the age of
12 at least, that is, until 1958.
I hope, Mr. Chairman, the data presented is sufficient to prove that
at best the artificial fluoridation hypothesis remains a hypothesis —
an attractive hypothesis, unfortunately prematurely kidnaped from
laboratories by monied bureaucracy, obsessed with social benevolence,
prostituted across the land by the enthusiastic echomen until it gave
birth to a social monstrosity proudly pointed at by the promoters as
a new milestone in public health which, I regret, is more likely to be-
come a millstone to the well-meaning promoters and earlier tomb-
stone to the innocent consumers of artificially fluoridated water.
In addition to all this, Mr. Chairman, I, as a citizen, am greatly
perturbed by the instability of the officiaj position of the Federal
Health Service on this whole question, ^t was only in 1948 that
in a pamphlet entitled "New Discovery Curbs Tooth Decay" Fed-
eral Security Administrator Oscar R. Ewing declared that "the only
method of proved effectiveness" is the direct or topical application of
sodium-fluoride compounds to the teeth; that "its effectiveness in
reducing dental decay has been thoroughly established."
FLUORIDATION OF WATER 177
A year later, Dr. Kniitson, Mr. Swing's subordinate, published a
scientific paper describing his improved method of direct applica-
tion. Not a word was devoted to artificial fluoridation of public
water. Yet 2 years later in a scholastical looking paper which I
have already quoted, he is committing the United States Health
Service with unbounded enthusiasm to fluoridation of public water,
reinforcing his position by quotations from 48 presumably scientific
papers with an unexpected exception of his own 1949 paper on direct
applications of fluoride to teeth. What disturbs me is not the radical
change in the Government's position but the suddenness of change in
a matter where new convincing experimental evidence cannot possibly
be secured with corresponding suddenness.
We all know of the availability of fluoride-bearing pills. If fluorid-
ists want to experiment with their children the crime and the harm
would be limited. Why insist on experimenting with the entire Na-
tion for the possible temporary saving of disguising one little molar,
allowing a mighty hoax out of a little molar grow.
Particularly after Newburgh's experimenters declared in their first
report, covering only 3I/2 years:
* * * artificially fluoridated water had the greatest prophylactic effect during
the period of this study on the teeth least often attacked by caries.
So even at the early stage, the fleeting "help" was limited to the
teeth that help themselves.
The Chairman. Your time has expired.
Mr. Paluev. Thank you.
The Chairman. I have been impressed with the care and precision
with which you have testified, based upon your study and expense.
You have the permission of the committee to revise and extend your
remarks, particularly extend them, if you wish to do so, in the record
so that the committee may have the full benefit of the information that
you possess.
Mr. Paluev. Thank you most kindly. I appreciate it.
STATEMENT OF MRS. AILEEN S. ROBINSON, SEATTLE, WASH.
The Chairman. The next witness will be Mrs. Aileen S. Robinson,
Seattle, Wash.
Mrs. Robinson. If — the chemical — fluoride, could be proved to be
of any benefit to dental health, it would still be highly improper to
administer it b;^JJie-4iigh-handed, compulsory method of adding it
to our warier-supplies. Such treatment is an infringement of indi-
vidual collstitutional rights. At the risk of their lives, their fortunes,
and their sacred honor, our fathers fought and died to establish in
this country — not a so-called democracy that would allow any major-
ity vote to tyrannize a helpless minority — but a Republic, with a Con-
stitution.
These Founders worked closely and prayerfully with God and they
based the whole foundation of our law upon the 10 Commandments.
They considered the individual rights of man as so significant that
they also included certain amendments called the Bill of Rights,
which outlines the law that a majority vote of citizens or officials may
not rule upon matters infringing stated constitutional rights of minor-
ities.
178 FLUORIDATION OF WATER
The first amendment specifically protects the religious rights of
individuals of different faiths — who may depend Avholly upon God,
and prayer, for their healing. The fourteenth amendment guarantees
individual privileges and immunities, and also protects our life and
liberty. As was stated by the judge in Shreveport before awarding
the injunction against fluoridation on January 5, 1954 :
There is a great difference between adding something to purify the water
and in adding something to the water in order to treat the people who drink
the water.
Fluoridation is a violation of the provisions of the Pure Food
and Drug Act. Such law provides that no deleterious substance may
be added to food — and water is defined as food. A beer company was
convicted and fined under this law in 1946, for merely having had a
trace of fluoride found in their product. And it was not necessary
to prove that the amount used was great or small — just the fact that
the fluoride should not have been used in food because it is a deleterious
substance. Pharmacologists have labeled fluoride as a toxic, proto-
plasmic poison. Cans of sodium fluoride found on drugstore shelves
are plainly labeled "Poison," including the familiar skull and cross-
bones.
Fluoridation is malpractice because neither Government bureaus,
city officials, nor the voting public, has any authority to so prescribe
for helpless neighbors and their defenseless little children — for all
time, and with no hope of escape from this medication.
Medical monopoly and so-called wonder drugs are not the final
answer to the question of health. Millions of intelligent and respected
peoJ3le depend upon wholesome, unadulterated food and drink for
healthful daily living — and longevity ; and millions have had to turn
away from medicine and surgery to other methods.
Honest practitioners of naturopathy, chiropractic, and other drug-
less healing do not lack for patients, their office are filled with those
who are looking away from the drugs and synthetic chemicals. It
is only under the Kremlin, the Nazis, or the Fascists that such schemes
as water fluoridation could be expected to be found.
Fluoridation got its first promotion from the United States Public
Health Service under the Surgeon General and the former head of
the Federal Security Agency, Mr. Oscar Ewing, using millions of our
tax dollars for every kind of propaganda, deceit, and promotion, and
Avith a total lack of any kind of dental or medical ethics. This mal-
pratice and violation of the Pure Food and Drug Act is still being
promoted under the new administration. Even though a clear and
decisive mandate of the people one year and a half ago proved that
the people demanded a change from this kind of compulsory or so-
cialized medical care. Instead of a correction of these practices, Mrs.
Plobby, our new head of the reorganized Cabinet-status Department
of Health, Education, and Welfare, it is significant that we still see
the violation by one of her departments of the statutes of another of
her departments.
We have implored of iSIrs. Hobby, and our other officials, to estab-
lish an honest administration of her Pure Food and Drug statutes —
and to stop this ma}})ractice by the bureaucrats — and with no response
from her.
FLUORIDATION OF WATER 179
We have seen no correction of tlie empire-building tendencies of the
United States Public Health Service, in fact the opposite seems to be
true because certain bills have been recently introduced into Congress
that would give increased power to the Surgeon General, and I refer
to H. R. 7oi)7 which intends to promote and assist in extension, etc.,
of Public Health Service — and for other purposes — what purposes?
The Surgeon General is empowered to approve or reject any State's
health plan ''"' * '^^ and he is ''authorized to train personnel for State
and local health work," and he may refuse grants — of our tax money —
if ''in the administration of the plan there is failure to comply sub-
stantially with such requirements.""
This is the kind of whiplashing we have been watching with regard
to fluoridation promotion sifting down into our local health bu-
reaus for years. Senate bill 2778 is nnich the same as H. E.. 7397,
raid we wonder if oui' Congressmen are blind to the enormous impli-
cations for future health experiments to be foisted upon the citizens
by this power-hunting bureau. The United States Public Health
Service or, more specifically, the Surgeon General that is mentioned
so many times in these two bills. We wonder what next he wdll plan
for us.
We have noticed that the first and foremost promotion for fluorida-
tion comes through the local public-health crowd, and we wonder just
how" much of our Federal funds are granted to the local bureaus.
This Federal money sifting down into our local areas is a direct viola-
tion of the intent of the tenth amendment — which leaves to the local
level all such matters as the local health problems.
Hundreds of outraged and tormented citizens have petitioned to
Mrs. Hobby for a correction of this forced medication — so far with
no success — so we urge the enactment of the proper legislation, at the
Federal level, in order to free the American citizens.
The United States Public Health Service has spent millions of tax
dollars for propaganda such as the large booklets No. 62, given out
by the thousands to P-TA members, and so forth; for expensive
glamour movies like "A Drop in the Bucket" ; for leaflets, and elabo-
rate displays sent all over the country; for travel expense of public-
health officials ; for various fluoride experiments and costs of process-
ing the so-called statistics; and for making large grants to such States
as in low^a : $o(3,450 to start 12 fluoride experiments in that State,
covering costs of equipment and training of personnel, and so forth,
in May 1952. The promoters state that fluoridation has been studied
for dozens of years and they probably mean in the natural fluoride
areas, ignoring the fact that the artificial fluoride experiments have
only been going since 1945.
The dentists and promoters state that *'93() communities, including
17 million people, are now fluoridated,"" implying that these 17 million
people are gratified and happy about this treatment. Their method of
tallying these 930 communities is strange to say the least, because, for
instance, instead of counting Baltimore and Washington, D. C, as 2
cities fluoridated, they add on the other 102 little districts attached to
the Baltimore reservoir, plus the 25 attached in Montgomery County,
plus the 27 attached in Prince Georges County, and then they add on
the other 4 attached to District of Columbia, plus Andrews Field, and
they cor.nt the wliole as about ''1(>0 communities fluoridated."'
180 FLUORIDATION OF WATER
The same kind of tally is used for Pittsburgh, it has attached
another 10 little districts, Wilkinsburg has 20 attached, Louisville has
19 attached to their reservoir, Indianapolis has 6, Portsmouth has 7,
and Miami and Easton, Pa., both have 7 attached.
In scarcely any one of these cities have the citizens been given
any choice in the matter. It has been installed by high-pressured
city officials, the same as in Washington, D. C., without allowing the
citizens to make their own choice. Indeed, they have scarcely even
been allowed to hear the other side of the controversy in their news-
papers. In many instances, fluoride has been installed in deep secrecy
and no announcement made until weeks later, if at all.
But an outraged and organizing citizenry is now making itself
heard. In at least 18 cities the citizens have put a stop to this practice.
At great costs they have obtained referendums and thrown out the
expensive equipment and supplies. In hundreds of the other cities
there are active citizens' committees now demanding a stop to this
treatment.
If there is any merit in the use of fluoride it may be easily taken —
in an exact, controlled, ethical doseage, by tablets, drops, capsules,
and several other methods, at far less cost than if administered by
the tons through the water supplies. A 10-cent capsule mixed with a
26-ounce package of table salt — the same as iodized salt — will lasc for
months, cost about 1 cent per month.
Pharmacies carry these products, and this is the only ethical, Amer-
ican way — and it may be stopped when necessary. The promotion
for use of thousands of tons of worthless fluorides makes one wonder
at the great and significant commercial aspects of this scheme.
Flouridation has been promoted w^ith many techniques and deceits
and some of these are revealed in the official Government transcript of
that direct testimony of the State dental directors in their fourth
annual conference, with the Public Health Service and the Children's
Bureau, Federal Security Administration offices, Washington, D. C.,
June 1951. The featured part of the 3-day program was "Promotion
and Application of Water Fluoridation," by F. A. Bull, dental director
for the State Board of Plealth, Madison, Wis.
In his opening remarks the Surgeon General, Leonard Scheele,
states that —
WHO — World Health Organization, had an obligation to concern itself with
problems of dental hygiene * * * the fact, too, that funds will now arise in the
course of the coming year to the grand level of about $7i/4 million for the whole
world, they are going to make some little start in this field * * *. Its job is to
have specialists who can go and set up demonstration programs and consult,
do an extensive training program through the device of fellowships * * *
obviously one of the biggest things facing us is the catalyzing of a real national
program of water fluoridation * * * and you will be having to worry about
whether or not glass will turn white and plastics will dissolve and bread raste
different * * *
Dr. Bull then addresses the other dental directors as follows:
Dr. Bull. What are some of the objections (to fluoridation)? The first:
Isn't fluoride the thing that caused mottled enamel * * *? You have got to
have an answer * * *. Now we tell them this, that at 1 part per million dental
fluorosis (mottling) brings about the most beautiful teeth that anyone ever
had. And we show them some pictures of such teeth * * *. We don't try
to say that there is no such thing as fluorosis even at 1.2 parts per million which
we are recommending. But you have got to have an answer * * *. And, in-
FLUORIDATION OF WATER 181
cidentally, we never use the term "artificial" fluoridation * * * we call it
"controlled fluoridation" * * *. Incidentally, we never had any "experiments"
in Wisconsin. To take a city of 100,000 and say, "We are going to experiment
on you, and if you survive will learii something" * * *. That is kind of rough
treatment on the public * * *. In Wisconsin, we set up "demonstrations."
Now in regard to toxicity * * * I noticed that Dr. Bain used the term "adding
sodium fluoride." We never do that ; that is rat poison. You add fluorides. * * ♦
But this toxicity question is a difflcult one. I can't give you the answer on
it. * * * I can prove to you that we don't know the answer to that one, because
we had a city of 18,000 people which was fluoridating its water for 0 or 8 months.
Then a campaign was started by an organized opposition on the grounds of
toxicity. It ended up in a referendum and they threw out flouride. * * * It's
tough. * * * So when you get the answer on the question to toxicity, please
write me at once, because I would like to know. * * * We think nothing of
going to a community and saying, "You should fluoridate your water" * * *
when we know it is going to cost them $50 per capita to get their equipment
* * * a little hard to handle is the charge that fluoridation is not needed. They
talk of other methods and when they get through adding up all the percentages
of decay that we can reduce by such methods, we end up in a minus. When
they talie us at our own word they make awful liars out of us * * * you are going
to have to combat it "^ * *.
Another tough question is that of the liability of the water department. * * *
First you need a positive policy by your State dental society and your State
board of health * * * a really positive policy * * * get a policy that says,
"Do it." That is what the public wants, you know * * * and make it em-
phatic * * * otherwise they wouldn't need public health people. What are we
here for?
* * * publicity that the local fellows can't handle * * * must be gotten out
from the State level * * * can come from the State board of health or the
fluoridation committee of the State dental society. And that committee can
assist in the prefluoridation survey? Is it to find out if fluoridation works?
No. We have told the public it works, so we can't go back on tliat. * * * You
want your prefluoridation data, so 3, 5, or any year from now you can go back
into these same areas and to the same type of survey and show the people what
they have got * * * make it look important enough so you can have it on
the State level. And when you do it on that level, don't get somebody on the
program who ends up, "But I don't think you should do it." * * * i jxist came
back from a meeting in Seattle, and a fellow said, when he got through with
his presentation, "But I could not recommend that anybody do this."
When we are having the press in and the public in, don't have anybody on
the program wlio is going to go ahead and oppose us because he wants to
study it some more * * * get over to the newspaper office. * * * They like that
* * * they get warmed up. * * * You remind them that the press has been one
of the greatest factors in the promotion of public health. You tell them how
fluoridation helps the poor devil who can't afford proper dental care. * * * You
have got to come out of that local meeting with a resolution from your local
dental society. * * * You have got one from the State. You have got one from
the State board of health, and one nationally. * * * Let me tell you this :
The medical audience is the easiest audience in the world to present this to * * *
go before lay groups, service clubs, PTA's, etc. * * * have a sample ordinance
all drawn up, so that all they have to do is either strike out something or add
what they want, put in the name of the town * * * now present the ordinance
to your city council. * * * The oflicials * * * have seen the reactions * * * of
the PTA groups * * * service clubs, union groups, etc.
Y'ou have got to knock their objections down. The question of toxicity is on
the same order. Lay off it altogether. Just pass it over. We know there is
absolutely no effect other than reducing decay, you say, and go on * * * don't
bring it up yourself. * * * Let me tell you the PTA is a honey when it comes
to fluoridation * * * jf yQ^ pa^^ keep fluoridation from going to a referendum.
Dr. DeCamp (Florida dental director). I would like, Dr. Bull, for you to go
back to Milwaiikee and do something to the vitamin products company * * *
which recently passed out this pamphlet * * * they were all ready to put the
final touches on fluoridation for the city of Tampa, serving 200,000 people. * * *
But the major and the city council got copies of this * * * and they tried to
turn thumbs down on this thing at once. We were stymied * * * can't you do
something about it?
182 FLUORIDATION OF WATER
Dr. Glover Johns (Texas). We have something parallel to this * * *. The
University of Texas had a research project on some white mice * * * there was
the rumor that this research project indicated that fluoridation of water supplies
causes cancer. This had knocked the pins from under us. We don't know how to
combat it * * *.
Dr. Bull. I wish I knew the answers * * * two-thirds of the deans of the
dental schools of the universities sa.ying that fluoridation is rat poison, and
should not be used * * * got to knock them down the best way you can * * *.
Dr. Johns. We are preparing a refutation statement * * *. Is that good
technique?
(Deceit?)
Dr. Bull. Yes, anything you can do is good technique. I think the best tech-
nique is the reverse technique * * * when they say yes, you say no.
(Deceit?)
Mr. Maier (senior sanitary engineer of division of public health). * * * the
criterion that we have been using is that if there is some 10 to 20 percent fluorosis
(mottling) in the community that would not be objectionable * * * there is
more fluoride being thrown away * * * in * * * industries, than the whole
country will ever use for fluoridating * * *.
The above testimony clearly indicates how the so-called endorse-
ments have been obtained for finoridation, and it is interesting to note
that an officer and representative of the American Dental Association,
Dr. Philli]) Phair, was in attendance at this conference. We can easily
now understand just how the endorsement of the ADA was obtained
for finoridation.
During the past few years I have carefully documented and com-
piled lists of approximately 400 cities that have either defeated or
refused or kicked out fluoridation and this list grows so fast I can
scarcely keep them n\) to date. If I wanted to tally this list in the
strange manner used hy the Public Health crowd and the dentists —
by counting all their little "communities fluoridated" — I would add
on, for instance, the additional 18 that are attached to Belleville, 111.,
when they refused fluoridation, and I could count Belleville as "19 com-
munities.'' In this method of tally I could very truthfully say that
the number of "communities refusing or throwing out fluoridation
would be about two or three thousand communities," totaling perhaps
about 30 or 40 million people, or more.
Fluoridation has lost its momentum; with all its ])ropaganda, it
has come to an almost complete stop as citizens and officials are becom-
ing aware of the other side of the controversy.
In Beverly Hills the city council stated that they "were not quali-
fied to medicate the people." In Daytona Beach the promoters re-
fused to sign legal papers assuming any responsibility for possible
damage in that council meeting, so it was defeated.
In Chicago it is now refused by officials for the first time, because
of its compulsion, toxic element, the increase of deaths in Grand Rap-
ids, allergies in people, objections of the food industries, and the
unanswered questions. In Worcester, Mass., it is declared unlawful
for that city, by the city solicitor.
In Ottawa, 111., there was the usual promotion for fluoridation, then
tests were made of their water from the deep wells which showed they
already had more than the recommended amount naturally. Their
teeth were no better than others ( Quincy Herald, November 30) , This
same kind of fraud was started in Chester, Va., by the promoters, after
which it was found that Chester already hacl more than the correct
amount in their water. The dentist admitted that "tooth decay among
FLUORIDATION OF WATER 183
Chester children is about as bad as anywhere else" (Albany (N. Y.)
Knickerbocker News) .
Hundreds of such cities have defeated fluoridation and others have
thrown it out because of its corrosive damage to equipment and pipes
and the bad results in some of the people. In some 18 or more cities
it is now discarded ; as in Sheridan, Wyo., where it ate up the pipes
in just 3 weeks, and in Williamstown, Mass., it clogged the equipment
and failed to operate properly. In Knoxville, Iowa, they couldn't
clear the clinkers out of the clogged equipment and no uniformity of
dose had been obtained. The whole ugly story was told on radio sta-
tion KRNT, January 20, 1954.
In Waukeeny, Kans., fluoridation was thrown out and an ordinance
passetl to prevent any such additions to their water except to purify
or soften it.
In New Martinsville, W. Va., it was thrown out because citizens
stated, "This is in direct violation of the fourteenth amendment. We
demand action."
In Tyler, Tex., it was thrown out by contention "its use is injurious
to health and that its presence. in public water constitutes enforced
medication."
In Delavan, Wis., after a terrific battle by PTA and other press
l)romotion, it was stated that —
* * * the poison hazard is great enough that your city council carries heavy
liability insurance — at your expense, of course — in case of public disaster, etc.
Tlien it was thrown out by vote on April 6, 1954.
And now, let us examine the reports of what has happened to the
people. Remember that we have been promised that there have been
no bad results from fluoridation. In Akron, Ohio, an attorney stated
to the councilmen that —
My wife became ill in January Her mouth became inflamed. It appeared as
though she had measles in her mouth. A doctor told us she was suffering from
'■fluorosis." We obtained new water * * * the inflammation disappeared * * *
When I am sick I go to a doctor. I don't go to the jimior chamber of commerce.
Oihers said they "itched" all over * * *
Judge Wanamaker * * * said that he has suffered headaches from drinking
that "fluoridated water" * * * said those who want fluoride can buy it at
drugstores.
Akron then threw out fluoridation.
In Wichita Falls, Tex., still fluoridating until they get their refer-
endum, there are many cases of skin rash and itching. Mr. and Mrs.
N. had severe stomach trouble, and both their sons had a "sore itching
condition" until they started using pure bottled water. H. E. W. lost
minnows in his fishing camp using the fluoride water and had to filter
that water through charcoal because the minnows died.
Dr. Parnell can't make his Kolner-Wasserman tests for syphilis
with that fluoride water even after distilling it three times, and now
has to procure rain water.
In Hastings, New Zealand, where a fluoride experiment was started
last year, they are organized now to throw it out, and a resident of
Hastings complained through the press that the fluoride water was
affecting her mouth.
In San Francisco, still under fluoridation. Dr. Gould's patients have
"distressing dermatitis of the whole body, a badly cracked and swollen
184 FLUORIDATION OF WATER
tongue, painfully inflamed inner cheeks and deep cracks at either
corner of the mouth."
In such cities as Sheboygan, the mottling has begun to show on the
teeth of those unfortunate children, and as Dr. Brehmer states, "these
teeth are not pretty." The mottled teeth have been noticed in New-
burgh, and we must remember that the dental experts have admitted
that this could be the case in a certain percentage of the children.
Tormented people in Britain, Wales, Scotland, New Zealand, and
Australia have asked for all the information we can send them about
other cities, and have implored for a release from the United States
inspired fluoride promotion which is stemming from the WHO
through traveling fellowships awarded to many foreign health officers
who are escorted through our fluoridation experiments and then re-
turn to their countries and try to install such experiments in their own
countries. We wonder just whose money is paying for all the promo-
tion.
In Milwaukee is a gentleman who had to give up his job delivering
mail because he got so sick when he had to drink so much water during
the summer months and now has to have bottled spring water near
him at all times. In such cities as Lakeland, Fla. ; Longview, Wash. ;
Tallahassee ; Cincinnati ; Austin, Tex. ; and Elyria, Ohio, the expen-
sive equipment has been bought and never used because of the reversed
decisions. In Saskatoon, Canada, the officials ordered the machinery
but so much opposition has obtained a plebiscite vote for the next
election and the $14,000 worth of equipment is not being used.
There has been a great, unending controversy about the increase
in deaths in Grand Rapids since fluoridation so we look aga«in at the
words of their own health officer. Dr. Prothro, who is quoted in the
October 28, 1952, Grand Rapids Press, in addressing the PTA Health
Institute, as saying:
Heart disease deaths in Kent County (Grand Rapids) still are high. Kent has
8 percent more deaths from that disease than any other county in Michigan.
There is a high incidence of cancer and accident deaths in the county * * *.
I know a family in Seattle who used a fluoride prescription until
they broke out with a strange kind of skin rash, mostly on the neck
and chin, so they stopped the use of this dose, and they tried it twice
to be smre it was the fluoride that caused the rash both times.
At a great, tremendous cost in time and money spent away from
their own little families, hundreds of citizens have battled or organized
together to wrest themselves from under the control of this tyrannical
Government Bureau. They have had to contend with a vicious dental
or medical group, a self-righteous PTA, or misguided chamber of
commerce, a domineering Kiwanis Club or Rotary or union organi-
zation, in most cases a vicious press, and sometimes even the local legal
association has dared to state that fluoridation should be accepted.
At the present time, individuals are spending their fortunes in court
and in appeals to higher courts to free themselves and all other Ameri-
cans from the forced medication of these power-grabbing bureaucrats
and professional officials.
We would ask that an investigation be made into the improper use
of funds by the United States Public Health Service and that exam-
inations be made to see if the schools of public health and our dental
schools are promoters for fluoridation because of the grants-in-aid
FLUORIDATION OF WATER 185
received from the United States Public Health Service. We ask for
a thorough examination of the ethics of both the American Dental
Association and of the American Medical Association, and of the
American press. And we would ask that the proper department bring
to justice all those responsible for the start of the fluoridation experi-
ments upon the American people.
We pray for an early enactment of the bill, H. R. 2341.
The Chairman. Thank you, Mrs. Robinson, Our next witness is
Dr. Leo Spira.
STATEMENT OF DR. LEO SPIRA, M. D., PH. D., M. R. C. S.,
NEW YORK, N. Y.
Dr. Spira. Mr. Chairman, my name is Leo Spira ; my address is 344
West 72d Street, New York 23, N. Y.
I am a graduate of Vienna University and I hold the degree of
doctor of medicine ; I am also a graduate of Prague University, being
a doctor of medicine of that university.
For my research work on animals on the subject of fluorine, extended
over a period of 4 years, I obtained the degree of doctor of philosophy
in medicine at London University.
I am holder of a diploma of member of the Royal College of
Surgeons, and licentiate of the Royal College of Physicians, London,
England.
I am member of the Medical Society of the State of New York and
of the County Medical Society of New York.
I have been approached by very many people from all over the
country, ever since I came to live and continue my work here in
November 1951, with a request to help in this fight against chronic
fluorine poisoning which is bound to come in due course as a result
of adding fluorine to the public water supplies. In reply to a ques-
tion on whose behalf I am giving evidence, I would say that I am
talking principally on my own behalf and on behalf of all those who
have the same opinion as I have, in the hope that I will be able to
convince, through my evidence and through my numerous writings,
that adding fluorine to the public water supply is, in my judgment,
wrong.
Mr. Chairman and members of the committee, my evidence is going
to be confined to the purely medical aspect of the action of fluorine.
Fluorine is a nerve poison. It affects the nervous system : its vege-
tative section which supplies the inner organs of the body and the
endocrine glands, as well as its central and peripheral sections — that
is to say, the brain, the spinal cord, and the peripheral nerves. The
long-continued daily ingestion of at least 1 milligram of fluorine,
equivalent to 1 liter of drinking water with a concentration of 1 part
per million a day, is sufficient to cause the first evidence of chronic
fluorine poisoning.
Organs regulated by the parathyroid glands — 4 glands embedded
1 each in the upper and lower pole of both the right and left lobe of the
thyroid gland — are most frequently affected. They are the skin and
its appendages, the teeth, nails, and hair.
Damage to the skin is manifested by itching, even without visible
cause, by outbreaks of boils and weals, by athlete's foot, and, in more
pronounced cases, by eczema in any part of the body.
FLUORIDATION OF WATER
.e teeth undergo changes characterized by mottling, which is
^jroduced by the ingestion of drinking water with a concentration
of at least 1 part per million during the period of calcification of the
permanent teeth — that is to say, during the first 8 years of life. Mot-
tled teeth are universally accepted as the first visible external sign of
(chronic fluorine poisoning. Its other effects are bleeding of the gums,
gingivitis, and pyorrhea.
The nails become so brittle that even a slight accidental knock on
a hard object — for example, the edge of a table — causes them to break
across. Chalky-white specks, patches, and horizontal lines, closely
similar to those observed on mottled teeth, develop on their surface,
giving rise to the designation of "mottled nails." The commonest fea-
ture is the occurrence of raised longitudinal ridges on the finger and
toe nails.
The hair falls out prematurely, leading to a more or less pronounced
baldness at an early age.
All these lesions are the result of a disturbed utilization of calcium,
which is stored in the body as a material as indispensable to life and
health as is oxygen. The calcium metabolism is regulated by the
parathyroid glands. If their normal function is interfered with by
the deleterious action of fluorine, the body is deprived of calcium, and
only the therapeutic administration of a calcium salt will replenish
the deficiency and improve the condition of the victim.
Lesions of the organs regulated by the parathyroid glands (skin,
teeth, nails, and hair) are frequently accompanied by brown patches
of skin on various parts of the body, closely similar to those encoun-
tered in chronic arsenical poisoning. They are evidence of a disturbed
function of another set of endocrine glands — the adrenals — which
legulate the pigmentation of the body. On treatment directed against
chronic fluorine poisoning, the brown patches of skin disappear.
Other evidence of fluorine aflecting the adrenal glands are low blood
jn-essure, general lassitude, tiredness, and lack of energ}^
The coexistence of large breasts in young men and of female distri-
bution of pubic hair, giving rise to the designation of "feminized
males," indicates that yet other endocrine glands are often affected by
the long-continued ingestion of toxic amounts of fluorine.
The fact that all these glands are regulated by the vegetative
nervous systenr indicates that fluorine has a predilection for it at its
origin, namely, at the base of the brain.
Moreover, those affected by fluorine in an advanced stage are sub-
ject to fits of depression and even melancholia, and to a feeling of
apprehension and irritability. It is thus obvious that the substance
of the brain itself is involved in these cases.
Neuralgiae in the arms and legs, and attacks of cram]is in the calves,
occurring mainly at night during sleep, are clear evidence that the
peripheral nervous system is likewise affected in chronic fluorine poi-
soning. There are attacks of "pins and needles," producing the sensa-
tion of deadness and numbness in the hands and fingers supplied by
the ulnar nerve. It is known that fluorine attacks the ulnar nerve
just as lead attacks the radial nerve.
There is severe constipation lasting 2 or ?> days in mild cases and up
to 7 days at a stretch in advanced cases of chronic fluorine poisoning.
Constipation is associated with excessive gas formation in the bowels
FLUORIDATION OF WATER 187
and with attacks of colicky pain in the abdomen. Blisters and cracks
form on the mucous membrane of the mouth, causing pain on eating
and talking.
The symptomatology of chronic fluorine poisoning, as here re-
counted, is based on an intensive clinical study which I personally
carried out in London, England, since 1922 and, more especially, dur-
ing the recent war on many thousand recruits, both male and female,
serving in the British Army. It was duly recorded in 34 papei's
published in important medical journals in this country, in Great
Britain, and on the continent of Europe.
The subjects examined were not exposed to any industrial hazard of
chronic fluorine poisoning, and tliey were living in communities whose
drinking water was either entirely free of fluorine or contained only
insignificant traces of the poison, not sufficient to cause mottling of
the teeth. It was, therefore, obvious that the fluorine causing these
signs and symptoms was derived from sources other than drinking
water. In fact, chemical analysis carried out by an expert public
analyst i-evealed traces of the poison in practically all the articles of
everyday food and drink examined, albeit only in quantities not suffi-
cient for any one of them by itself to cause the mottling of the teeth
and other coexistent signs of the disease.
It is thus not tlie concentration of fluorine in any one article of food
and drink that causes the disease, but the sum total of the poison
ingested in the course of the day which must be considered. The
average cup of tea, for example, contains as much fluorine as is con-
tained in 2 to 3 tumblerfuls of drinking water with a concentration
of 1 part per million of the poison. Sea fish is another important
source of fluorine intake, sardines, for example, containing a concen-
tration of as much as 15.6 parts per million. The chemical substances
used for sedimentation, filtration, purification, and sterilization of
drinking water derived from rivers, lakes, ponds, and so forth, were
found to contain large amounts of fluorine.
For spraying fruit trees and vegetables, fluorine compounds are
used, and samples of chemical fertilizers were found to contain as
much as 400 parts per million of the poison. Dissolved in the soil, it
is absorbed by plants and introduced into the body. In the manufac-
ture of aluminum, too, which is widely used in the kitchen, the fluorine-
mineral cryolite, is an unavoidable raw material. In the process of
cooking, acids and alkalies contained in the food corrode the metal
and set its impurities free so as to contaminate tlie food.
Fluorine is a powerful insecticide, fungicide, and rodenticide, and
has replaced arsenical preparations as a preservative added to canned
food, fruit, juices, and so forth, since its use is not strictly regulated
by law as arsenic is. We are thus in fact surrounded by fluorine and
caught in its trap, without being able to escape or to protect ourselves.
Fluorine is a cumulative poison, and the amount accumulated and
P constantly increased by its daily ingestion with numerous articles
of food and drink exerts a suppressing effect on the enzymes, material
indisi:»ensable for the proper utilization of food and for the mainte-
nance of the organic functions of the body. The harmful effect of
fluorine will depend, amongst others, on the susceptibility of the
person ingesting it, on the quantity ingested, and on the length of
time during which it has been ingested.
48391—54 13
188 FLUORIDATION OF WATER
These being the true facts concerning the action of fluorine, there
is no need for an undue stretch of the imagination to realize that
any increase, however slight, in the amount of the poison ingested
is bound to increase the risk and gravity of chronic fluorine poison-
ing. This is precisely what would happen if to the amount already
ingested a further dose would would be added to the drinking water.
Tlie margin between the tolerated quantity of the poison and the
quantity producing signs and symptoms of poisoning is very narrow.
The risk of transgressing the threshold of fluorine tolerance in the
older generations, as well as in those chronically ill, suffering, for
example, from kidney disease and unable efficiently to excrete the
poison, is a very real one.
In view of all these facts, it is utterly impossible to state whether
the addition of as little fluorine as would make up a concentration
of one part per million in the drinking water could or could not be
detrimental to health, since there is no person in the whole country
whose body was entirely free from it before a further amount of the
poison has been added to the drinking water.
To ascertain that the clinical findings obtained on man were in
fact due to nothing but the action of fluorine, I carried out animal
experiments at the department of physiology, Middlesex Hospital
Medical School, London, England. Gradually increasing doses of
sodium fluoride were added to the drinking water of experimental
rats. It was observed that, whereas in man the ingestion of drinking
water with a concentration of as little as 1 part per million is suffi-
cient to produce mottling of the teeth as the first external visible
evidence of chronic fluorine poisoning, in my rats mottling was pro-
duced by the ingestion of a water with a concentration of not less
than 60 to 100 parts per million of the poison. This means that
man is 60 to 100 times more sensitive to fluorine than rats are.
In the course of the experiments several signs of poisoning developed
which were identical with those clinically observed on man. The
earliest among them was intense scratching without any visible cause.
Later on, deep sores developed on the skin in various parts of the
body, accompanied by loss of hair. On the scalp a baldness occurred
which was very similar in its distribution to the baldness seen in
man. On replacing the fluoridated water by distilled water, which
is free from fluorine, and on addition of calcimn to the food, the sores
healed promptly and there was a complete regrowth of hair over
the denuded areas.
X-ray examination showed a diminished scrotal shadow, and the
testicles degenerated to such a degi-ee that they could be regarded
as having to all intents and purposes disappeared altogether.
At autopsy, the thyroid gland was found to have undergone pro-
found changes; it was enlarged and histological examination revealed
a lesion similar to that observed in toxic goiter in man.
The kidneys where the organ showing advanced damage ; under the
microscope they could not be distinguished from those seen in chronic
nephritis (Bright's disease) in man.
Several investigators reported the development of gastric and du- 1
odenal ulcers in their experimental animals. I could find none in
my rats, probabh^ due to the fact tliat I increased the concentration
of fluorine in their drinking water slowly.
FLUORIDATION OF WATER 189
The results obtained from the clinical examination on man and
from the animal experiment were significant enough for me to try
to find out whether they could be utilized in a practical manner for
application in certain diseases of a hitherto obscure origin.
A man suffering from chronic nephritis (Bright's disease) in its
terminal stage was submitted to treatment directed against chronic
fluorine poisoning, after every kind of treatment had failed. After
4 weeks' treatment he was restored to a useful life.
In another man, a gastric and duodenal ulcer, which radiologically
had the appearance of malignant degeneration, was completely healed
as a result of treatment directed against chronic fluorine poisoning.
After 5 weeks, no trace of either of the two ulcers could radiologic-
ally be detected.
Children wlio since birth were for several years afflicted with severe
eczema all over the body, for which no external treatment brought any
relief, were after 2 or' 3 months' treatment directed against chronic
fluorine poisoning completely cured without any local applications.
Of two patients suffering from netal illness, which was complicated
by the presence of brown discoloration of the skin characteristic of
chronic fluorine poisoning, one could be discharged from hospital
as completely cured from both mental illness and the pigmentation of
the skin following not more than 3 months' treatment directed against
chronic fluorine poisoning; the other was considerably improved.
The action of fluorine is practically identical with that of arsenic.
In fact, tlie two poisons occur in nature frequently together. Where-
as, however, the methods of detecting even slight traces of arsenic
are reliable, those for fluorine have not yet reached the same degree
of accuracy.
Further thorough study of the action of even small doses of fluorine
is a matter of vital importance. Basing their harmful effect, when
ingested with fluoridated drinking water on top of quantities con-
taminating everyday articles of food and drink, on cursory inspection
alone is not admissible. My own endeavor to carry out large-scale
treatment directed against chronic fluorine poisoning on a representa-
tive number of patients at hospitals for mental and other chronic
diseases of a hitherto obscure origin failed mainly because of regu-
lations which decree that, at the age of 65 years, no medical man
shall work within the walls of any hospital.
Mr. Chairman and members of the committee, this is a very con-
densed short resume of a work which was extended over more than
a quarter of a century. In the course of my investigation, clinically
carried out whilst I was serving in the British Army, and experi-
mentally at the department of physiology, Middlesex Hospital, Med-
ical School, London, England, every step I took was supervised by
my chief and by my colleagues who watched the progress of the work.
Needless to say, the results of my work would not have been accepted
for publication by the outstandingly important medical journals in
this country, as well as in Great Britain and on the Continent of
Europe ; if they would not have been verified as being based on truth
ind nothing but the truth. In the course of my investigations, both
?linically on man and on experimental animals, I had a large number
i :)f lantern slides prepared, and they show every step which I took
I rt the work.
190 FLUOR ID ATIOX OF WATER
I lioped when I eaine here that I would be allowed to show you these
lantern slides, which I brouoht with me. Unfortunately, I realize
the time is too short and facility is lackino- for me to be able to show
Mil at I have done.
Should it be necessary, I will be happy to be at your disposal and
show these slides. They will depict the story of what my work has
achieved better than any spoken or written word can.
Thank you, ^Mr. Chairman and members of the committee, for hav-
mo; iiiven me the chance to say what I had to say durino- the very
short time at my disposal.
The riiAiR:NrAN. Dr. Spira, it has been a very great pleasure and
very helpful to have had the benefit of the testimony that you have
presented to the connnittee. We realize that it is a resnlt of many
years' study and careful observations upon your part and that you are
convinced as to the correctness of the views you have expressed.
And Mrs. Robinson, I think, should be commended for the fact that
she irave you her time, in order that you mio-ht have an opportimity
of o-ivino- an extended explanation of the work and study that you
have made in this matter.
]N[rs. Roiuxsox. I thoujrht that you would want to hear Dr. Spira
and what he had to say.
The Chairman. I regret that the time is such that we do not have
the opportunity of seeing the pictures but if any members of the
committee desire at some off-hoiu" to see them, I am sure that you will
be glad to show the pictures, if they will so indicate to you.
Dr. SriKA. Thank you very much. I very much appreciate that.
The Chaik:viax. The committee will recess until '2 o'clock. In doing
so may I anucnince that there are, according to my list, two witnesses
in opposition who have not been heard. That is Dr. Paul Manning
and Dr. ^[ax Day. Am I correct in that statement?
It will be the intention of the connnittee when it meets at 2 o'clock
to hear you 2 gentlemen so that the first witness after we reconvene
will be you 2 gentlemen.
There have been some who have spoken for the opposition this
mornitig, and that will enable us to give this time to you. After that
we will proceed to hear the witnesses in opposition.
The committee will stand in recess.
(Thereupon, at 12:28 p. m., the committee recessed until 2 p. m.,
of the same day.)
AFTERNOON SESSION
(The committee reconvened at 2 p. m.. pursuant to recess.)
The Chairman. The first witness will be Dr. Max Ginns, senior
dental consultant, "Worcester City Hospital, Worcester, Mass.
STATEMENT OF DE. MAX GINNS. SENIOR DENTAL CONSULTANT,
WOECESTER CITY HOSPITAL. WOECESTEE. MASS.
Dr. Ginns. Mr. Chairman and members of the committee, my name
is Dr. ^lax Ginns of Worcester, ^lass. I should like to submit this for
the record.
(The information submitted by Dr. Ginns has been placed in the
committee files.)
FLUORIDATION OF WATER 191
Dr. GiNNs. So that the proponents may be fully informed, I shall
state my qualifications.
I am a graduate of Tufts College Dental School.
I was appointed chief of dental service, Worcester City Hospital,
in 1921. Also in charge of dental clinics in the out-patient depart-
ment.
I was formerly a lecturer on oral diseases at the cit}^ hospital
Nurses Training School.
I established training for dental interns, city hospital, giving in-
struction in oral surgery, dental diagnosis, and clinical dentistry.
I was chief dental surgeon, with rank of captain. Dental Reserve,
with the 3L5th Cavalry until 1938.
At present I am senior dental consultant, staff of the Worcester
City Hospital.
I served as chairman. 1942, of the Emergency War Study Club
dental program.
I was formerly director of Quota Club Clinics.
I am past chairman of the educational committee of State and
local dental societies.
I am past chairman of the dental health councils. State and local.
I am a member of the American Dental Association, the Massachu-
setts Dental Society, and the Worcester District Dental Society.
I was appointed chairman of a special committee to reexamine the
proposition concerning fluoridation of Worcester water supply by
the local dental society in December 1951.
I was chairman of the Alpha Omega Dental Society in 1951-52.
The Chairman. You may be seated, Doctor.
Dr. GiNNS. As a loyal member of the ADA back in 1946 I, too, was
very enthusiastic about topical fluoride treatments for the prevention
of decay, until I found out that its value was highly exaggerated.
As time went on I gradually acquired information that brought about
a reversal of my former attitude.
My visits to Hereford and Amarillo, Tex., and other points in
Texas, and then to Xewburgh and Kingston, N. Y., and then to Brant-
ford and Stratford, and then to Farnumsville, Mass., 5 miles outside
of the city of Worcester, revealed shocking variations, with the one-
sided story I had been given, through the ADA and Public Health
literature. You shall see for yourselves as I go on with my exper-
iences.
I have had to curtail mv talk, so I shall present for your considera-
tion a petition which I obtained from 119 Worcester dentists.
By tlie way, I have a special delivery that came to me yesterday,
to my hotel, from 10 physicians of the Massachusetts Medical Society,
whohave signified their desire to add their names to the petition of
the 119 Worcester dentists opposed to fluoridation.
I should like to read my petition. This as a photostatic copy for
your inspection, if you wish, of the original ])etition. Tlie petition
is as follows :
Petition (ipposed to flu tridati n of vrorct ster water snitplios. We, the under-
sigued Members of ADA. Massaeiiiisetts Dental t^oeiety and Worcester District
Dental Society. haTing heard, since approval without discussion prior to ap-
proval, the other side of the lluoridation plan ; and having learned of its danger-
ous and unscientific nature ; that it is not essential to development of good
teeth : and that it does not prevent tooth decay ; that there are better and
192 FLUORIDATION OF WATER
less devious ways to control tooth decay without pollutiug our water supplies:
and compelling an entire Nation to drink medicated water wliicli is. of no value
to them ; which is known to be harmful to all human beings as a slow and ac-
cumulative poison ; that all benefits attributed to fluorides are not due to flour-
ides at all, but are due to better nutrition, better hyyieue, and better super-
vision. All the foregoing: statements, being supported by universities in many
parts of the country, by eminent scientists, biochemists, physicians, dentists,
we demand that this hollow approval of the Worcester District Dental So-
ciety, obtained by telling only one side of the fluoridation story, and blocking
every attempt to fully discuss the harmful side of fluoridation.
We demand that this hollow approval be rescinded.
Then follow 119 signatures of Worcester dentists. As I said, now
there have been 10 physicians who have sent me this to be added to the
list, and there will be more. The list of 10 physicians comes as a
result of my talking to the medical society before I left Worcester.
The medical society has been put in a very embarrassing situation.
They know nothing about fluoridation, they admit, and many of them
do not know it has even been approved. They have never heard of a
meeting on fluoridation in the medical society, pro and con. It was
simply obtained by a rtibber stamp of the medical society, approved
by a few of the executives who were good fellows and O. K.'d it. That
is all they know about it. They now realize they are in a position
where they must answer to the people, because they have been silent
too long.
Now I want to speak about home rule and referendum, if I may ;
home rule against ruling the home.
Fluoridation began in 1945 in Newburgh and Kingston, N. Y., and
other pilot areas as a strict secret to be kept under wraps for 10 years.
The "strict secret to be kept under wraps for 10 years" has been quoted
here. See Public Health Conference June 8, 1951. That document has
been quoted here.
It planted its one-sided propaganda without asking the people.
Public Health bypassed the medical and dental profession. Public
Health arrogated unto itself mandatory powers without any attempt
at home rule. They ruled the homes of the commmiities by pressure
and compulsion.
About 1946 topical application to teeth — the swabbing of the teeth —
was praised to the skies. They made all the claims for topical that they
are now making for fluoridation of water supplies. Topical fell flat
in about 2 years, and the rumblings of fluoridation of water supplies
were being heard.
A definite pattern developed in our society to control thought and
speech. I have here something which you may obtain, perhaps, called
Securing Community Acceptance for Fluoridation Through a Citi-
zen's Committee for Fluoridation ; the American Dental Association.
Some of these were even printed at city expense in our own city hall,
with no identification as to where they came from. They were pur-
ported to come from the ADA, but actually they came from city hall.
In this pamphlet, I talked of thought control and speech control.
Here is a list of "what you do say and what you do not say." You
will notice that this pattern will be followed as a rule by proponents.
Pamphlets of indoctrination What To Say and What Not To Say
were mailed to the dental profession. Several hundred were printed
at city hall at taxpayers' expense.
FLUORIDATION OF WATER 193
Dr. Bull has been mentioned here. In the Journal of the American
Dental Association, February 1952, he said,
You must not tell the people. There may be some undesirable side effects. It's
another sure way to defeat any or all programs.
Fluoridation went on for 5 years before Public Health accepted
it, from 1945 to 1950, Please note. And even in 1950 and as late as
June 1951, they admitted they did not know about its toxicity or
what its harmful effects might be. These are quotes from their own
documents. Reference June 8, 1951.
All along proclaiming to the people "fluoridation was safe," "no
harm seen," "3 million people had been drinking it" and so forth and
so forth; while wrangling amongst themselves looking for alibis.
They were still without an answer to toxicity, and are still without
the answer today.
I want to show you gentlemen, if you have not heard about it, in
these natural fluoride areas, millions of gallons of Ozarka water are
being sold in carload lots in cities in five States. I am drinking it
here* now, because I will not drink fluoridated water. I may have to
take the food, but I am keeping it down to a minimum.
Here is Ozarka water. This is a photostatic copy of the size of
the carton. It cost me about $16 to bring it here, but I wanted to show
it to you gentlemen. They pay $1 for 5 gallons in these naturally
fluoridated areas, where proponents claim no harm is seen." Why?
To avoid mottling decay, gum diseases, and crooked teeth.
The question is often asked : What has crooked teeth go to do with
it? As you have heard, fluorine is an antienzyme. There are many
authorities for that. Professor Box of the University of Toronto is
one of many.
There is interference with bone development, causing a jumbling of
the teeth.
In the same year, 1950, one of the reasons you do not see many more
dentists willing to come out against fluoridation because the mouth-
piece for the dental profession comes through Public Health. I hap-
pen to be one of a number who would not yield to this kind of thought
■control. In the same year of 1950, our dental society Code of Ethics
was revised. Section 20 says — and there are many people who do not
know about it :
Education of the public. A dentist may properly anticipate in a program for
the education of the public on matters pertaining to dentistry, provided, such a
program is in keeping with the dignity of the profession and has the approval of
the dentists of a community or State, acting through the appropriate agency of
the dental society.
I ask you, gentlemen, is this to be our pattern for the future ? Are
you willing to make your dentists vassals of the State? I for one
refuse to become one.
Here is an excerpt from the Dental Health Council, January 9,
1952, Boston, Mass. This comes from the assistant secretary of the
Council on Dental Public Health, and it reads :
Almost without exception, administrative changes alfecting dentistry are being
made with absolutely no consultation with the dentnl profes^sion in the States
involved. It will be necessary to foresee the possii)ility of such situations and
to support positive action before the administrative pattern has been irrevocably
changed. Dr. W. Philip Phair. D. D. S.
194 FLUORIDATION OF WATER
I want to say, you cannot build hardness into teeth by adding fluori-
dation. Here are teeth [exhibiting teeth] that come from Aurora,
111., exposed to fluoridation for years.
Here are teeth [exhibiting teeth] that come from Worcester, Mass.,
subjected to the same acid influence of lactic acid you find in the mouth.
I defy any public health man to give me a tooth from any area that
will not succumb to acid.
The chemico-parasitic theory of Miller, which we all accept as of
this time, is the theory of decay, the chemical parasitic theory. It is
not a question of hardness. That is a fallacy. It is a contradiction of
theory taught in the schools, which is a matter of record in our text
books. You can subject any tooth from any area, and it will succumb
to acid and become decalcified. It is a matter of chemical environment
and not a mechanical hardness.
Here are the teeth to show it, if you would like to see them. [Ex-
hibiting teeth.]
I want to say that fluorine is not essential. In the city of Bridge-
port, Conn., where the hygienist originated, Dr. Fones in 1915 t» 1918
produced remarkable results by training nurses to be what we now
know as dental hygienists. I do not see the dental liygienists on the
list of approval of American Dental Association. They are the most
closely allied to the dental profession, and they only exist in our
offices because Dr. Fones produced a reduction in tooth decay up to
57% percent in the schools of Bridgeport, Conn., through good hy-
giene, good nutrition, and good supervision.
If it w^as done then, it can be done now, which proves fluorides are
not essential.
At Farnumsville, Mass., outside of Worcester, we have conducted
tests on this.
I have a letter from the State public health department proving that
in these natural fluoride areas decay is just as rampant as any place
else — 5,000 schoolchildren in the city of Worcester were subjected to
topical application which was supposed to do everything fluoridation
is supposed to do. In 2 years the local public health reported it was
a complete failure.
I perhaps will conclude at this point. I do not want to run over
into Dr. Manning's time. If there are any questions I would be glad
to answer them.
The Chairman. Any questions, gentlemen ? ]Mr. Heselton ?
Mr. Heselton. Doctor, you quoted from some pamphlet which I
believe you had, Things To Say and Things Not To Say. I was not
clear as to where that pamphlet was issued. I thought you said it
was city hall.
Dr. GiNNS. Some of these were printed at city hall, purporting to
come from Chicago. This is on the cover. It is marked^ —
Securing Community Acceptance for Fluoridation Through a Citizens Committee
for Fluoridation —
issued by the American Dental Association Council on Dental Health,
March 1952 ; and they must have copies of this. It says here :
Do not say this and do not say that.
I will describe it to you. It says :
Do not use the words "artificial fluoridation." Do not refer to "sodium flu-
oride." Do not use the words "rat poison."
FLUORIDATION OF WATER 195
By the way, they were the first to use the words "rat poison.-' Tliey
were the first, and they object to it now.
JNIr. IIesei/iox. I was interested in the document.
Dr. GiNNS. O. K. There is more here.
Mr. Williams. Mr. Cliairman^
The Chair3Ian. Mr. AVilliams.
Mr. "Williams. Dr. Ginns, I have been unable to attend these hear-
ings before tliis afternoon. I must confess complete ignorance on
the subject of fluoridation. I have listened to what you have had to
say with a great deal of interest.
In the photostat of the newspaper clipping which you passed around
among us, I noticed that you are quoted as making reference to the
terms "secrecy'" and "coercion."
1 quote from what you have to say, reading from this clipping :
"The pi'ufessioiial societies have lost the ball," Dr. Ginns told a legislative
committee.
Going further the article states :
Charging that the fluoridation movement has been advanced "with secrecy
and coercion" —
you were quoted as referring to it in that sense.
I am not a doctor. I know nothing about medicine. I hardly know
what the bone of contention is in this particular argument, other than
that one side says water treated with fluorine will improve the health
of the teeth of the people who drink it, and the other side says, as I
understand it, that it is a slow poison.
I am just wondering wdiat ''sinister'' movement, as you would indi-
cate, is behind the fluoridation of water, and what is to be gained by
those who seek to have the water so treated, perhaps, other than a
sincere desire to improve the health of the public.
Dr. Ginns. Well, if I had the time to go into my complete presen-
tation I could have covered that to a degree. It is quite a lengthy
story. I do not know how far you want me to go with it.
I would like to say this: It has been said here this morning that
highly eminent authorities have been quoted in favor of fluoridation.
Maybe that will answer your question, to some extent, if I quote some
authorities.
Mr. Williams, Is the profit motive involved in any way ?
Dr. Ginns. Yes, Beginning, it started with the FSA, They are
objecting to Federal interference. It all started with the FSA.
I do not want to mention names. Perhaps I will stay away from
that. But Oscar Ewing was Chief of FSA at the time he was chief
counsel of the Aluminum Co. of America. It seems to stem from
there.
If you will read the Congressional Record, Congressman Miller has
referred to it. You will find much of that in the Congressional Rec-
ord of Congressman Miller a year ago,
I would like to give you some authorities to substantiate that. Dr.
Bort G. Anderson, the associate professor of surgery at Yale Uni-
versity School of Medicine, says that this problem cannot be solved
by parliamentary maneuvering. Fluorine is not the answer to dental
decay.
The Forsyth Dental Infirmary has been mentioned, with Dean Mar-
jerison and, I think. Dr. Herme.
196 FLUORIDATION OF WATER
I shall mention Dean Marjerison, now the director of Forsyth Den-
tal Infirmary and formerly dean of Tufts College Dental School, who
is opposed to fluoridation. I have it here.
The Guggenheim Foundation of New York City, which is a large
clinic, as you know, for the special benefit of children, had experience
with topical and found more decay in about 175 children after topi-
cal fluoride than before these applications.
Now, the University of Texas has been mentioned here. It is op-
posed to it. At least some of the professors are ; we know about Dr.
Taylor.
The University of New Mexico wrote a pamphlet on the menace of
fluorine to health.
At the University of Arizona, with 9 to 10 parts per million, the
Drs. Smith recommend filtering it out of their water over powdered
bone.
I mentioned the University of Toronto. Professor Box has indi-
cated that where fluoridation is present naturally, the prevalence of
gum disease is very high.
Wliom are we going to believe? Either the schools or the public
health men.
Mr. Williams. My purpose in asking the question was more to try
to ascertain the background of this controversy than it was to at-
tempt to distinguish as to the merits of the arguments of the two
opposing sides.
I will ask you this question, as to the bone of contention here, as to
whether we should or should not permit this to be done. Does the
controversy stem from an honest disagreement among men of medi-
cine as to the benefits or the dangers of fluoridation ?
Dr. GiNNS. It does result from an honest difference of opinion, and
it has never happened before in the history of medicine that we have
split on an issue. On penicillin or other things we have sat around
the table as professional men did and we discussed our problems and
we respected each other's opinions.
Mr. WiLLL^MS. My question is this : Does this argument stem pri-
marily from that, or does it go deeper and have its roots in some mer-
cenary consideration of some selfish interest group of some kind?
Dr. GiNNS. I think it is both, perhaps. It has a mercenary back-
ground and it seems to be a blunder on the part of certain men who
will not admit that they are wrong, although eventually they will.
That is my bone of contention.
We are not advocating it. It has been asked of us :
Do you think public health will deliberately harm the people?
That question should be revei-sed. We are not advocating anything.
It is incumbent upon them, I think the Supreme Court ruled, as I re-
call, that those who advocate prove beyond a shadow of a doubt that
there is no harm to fluoridation. We have the benefit of the children
at heart. Are we murderers ?
It is put in such a way that you would think that they were the
benefactors and that we have no love for children.
I have worked for children all of my life, without any salary, on
the city hospital staff, so I have had an interest in children.
Mr. WiLLLAMS. Granting that the issue of whether or not fluorida-
tion is good or bad is not and probably will not be resolved for quite
FLUORIDATION OF WATER 197
some time; nevei-tlieless if we could set that particular issue aside for
the moment and assume that fluoridation were completely harmless,
who would profit by adding fluoridation to the water?
Dr. GiNNs. Well, you see, it started out with a $7i/^ million proposi-
tion, to begin with.
Mr. Williams. That is what I am getting to. What is behind this ?
Dr. GiNNS. $71/2 million to begin with. It is in the record. To
propagandize.
At the meeting of the child's health conference that is a matter of
record. Many millions have been spent since. In 1952 an appropria-
tion of $2 million more w^as asked for fluoridation. I think the Con-
gress cut that down to $250,000. A month later I read in the Wash-
ington report they had taken all the funds away.
Mr. Williams. Who received that money, and in what way was it
spent ?
Dr. GiNNS. I think that was allotted to the American Dental As-
sociation research group. I have it, in the Washington News here.
Mr. Williams. Do you feel that the profit motive has an influence in
the fluoridation movement?
Dr. GiNNS. There is the sale of equipment. There is the sale of
chemicals which have jumped in price. There are maintenance bu-
reaus, statistical bureaus, and a whole rigamarole of bureaus off one
tree. It certainly runs into money.
They talk about 10 or 14 cents per capita to each person, but they
do not talk about the millions of dollars that have been spent. That
is a matter of record. Anybody who wants to laugh at it can, but
it is in here. I do not know whether I have it with me or not. I
could not bring everything. Those things are a matter of record.
Yes, there is money in this fluoride bill.
Mr. Williams. That is all, Mr. Chairman.
The Chairman. Mr. Hale ?
Mr. Hale. Dr. Ginns, do you know historically when the first use
of fluoridation in the city water supply occurred in this country ?
Dr. GiNNS. You see, much of this has been kept a secret, but I do
know as far back as 1945 artificial fluoridation came into being. That
I do know. That was done at Newburgh; Kingston; Evanston, 111.:
Brantf ord ; Stratford : and some mental institutions in Massachusetts
where children who have no way of protecting themselves were sub-
jected to this mass experiment.
Why was it necessary to spend $7i/2 million to prove by artificial
means through artificial statistics a natural phenomena that they
claim had already been proved by nature ?
Mr. Hale. I do not want to go into that.
Dr. GixNS. Well, that is it.
Mr. Hale. All I want to know is the chronology of the thing.
Dr. Ginns. In 1945 is when artificial fluoridation came in, so far
as I know. Artificial fluoridation.
Mr. Hale. Some fluorine — a natural deposit — is in some parts of
the country ?
Dr. Ginns. Yes, but there is smog, naturally, in some parts of the
country. You would not say it was essential everywhere because there
was some smog somewhere.
198 FLUORIDATION OF WATER
Mr. Hale. Have you any idea how many people in the United
States today are drinking: water which has some artificial fluorine
content ?
Dr. GiNNS. I can only go by what I read in the public-health rec-
ords, and they claim it is about 18 million people ; but I have shown
you in these areas we have an equal amount drinkino- this and paying
$1 for 5 gallons to get away from it.
]Mr. Hale. Where does that Ozarka water come from ?
Dr. GiNNS. From the Ozark Mountains, Eureka, Kans. ; and it is
wonderful water.
Mr. Hale. I would like to reconnnend the Poland Spring water
from Poland, Maine.
Dr. GiNNS. I will drink that, too. I will drink anything but fluo-
ride water.
Mr. Hale, I can assure you that is absolutely pure.
Dr. GiNNS. The Poland, Maine, water is good water, and I hope
that it can be kept that way.
Mr. Hale. Thank you.
The Chairman. Are there any further questions, gentlemen ? If
not, we thank you. Dr. Ginns, for your appearance and the testimony
you have given.
Dr. GiNNs. Thank you.
The Chairman. Dr. Paul Manning of Springfield, Mass., a prac-
ticing dentist and a consultant in physiological chemistry is our next
witness.
STATEMENT OF PAUL MANNING, D. M. D., PRACTICING DENTIST,
SPRINGFIELD, MASS.
Dr. Manning. Mr. Chairman, my name is Paul Manning, a prac-
ticing dentist of Springfield, Mass., registered in Massachusetts and
in California in the year 1913.
Because some aspersions have been cast upon objections to the mas-
sive experiment called fluoridation. I would like to say that the as-
persions to the efl^ect that we are incapable of harmonious agreement
with our colleagues in the profession — may I be seated, sir ?
The Chairman. That is your privilege.
Dr. Manning. I would rather stand, sir. unless I am ordered to. I
understood that the witnesses were ordered to be seated.
I would like to explain that as a young man I held office in the
dental societies. I think it is of no importance, but evidently it has
developed in the course of these hearings that it is of some importance
to put it in the record, so I put in a matter which in the ordinary course
I have deemed unimportant. I wish to conform to the rules and
tendencies of the committee to the fullest extent.
Mr. Chairman, we have asked politely to be left out of the massive
experiment called by the fanciful and nondescriptive name of fluorida-
tion of water supplies, a term which you will find, I think, in no dic-
tionary ; not in any I have examined.
It is a perfect trade-mark. I am quite sure it is registerable as a
trade-mark by its inventors. I would like to discover the name of the
inventors of the term "fluoridation." If it were possible to do so we
would be one step along toward the eventual discovery of the motiva-
FLUORIDATION OF WATER 199
tion for what is most certainly the most foolish and imjiistifiable
experiment ever carried out either upon voluntary or upon involun-
tary human subjects.
1 lune attempted a number of times to define "fluoridation." I
attempted first to call it "fluori nation" and I tried to push my col-
leagues out of the silly position of inventing a name for a newly
invented procedure. The success that I hope for was denied by hard
and obstinate attitudinizing on the part of my colleagues who have
committed themselves to a vain folly by a method never before con-
ceived or considered by any professional group in the Avorld ; refusing
to be diverted from their original purpose. So we passed on.
I would like to read to the committee, Mr. Chairman, one of the most
exciting pieces of prose — composition — I have ever read either in the
scientific line or in the lurid fiction which I may have followed as a
younger man. This is an extract which must come in here in my opin-
ion, if you will permit it, in the limited time which is granted, as
documenting the arbitrary selection. I would like to put "selection" in
quotes if you please, to refer it back to the procedures which were car-
ried on in Nazi Germany historically, to the arbitrary selection of
involuntary and unconsenting human subjects of medical experi-
mental research and treatment with fluorides ; which is to say, with a
fluorine compound, also known as fluorene compound.
The excerpt which I asked to be permitted to make is from Water
and Sewage Work, a reputable trade journal with a scientific cast —
98 : o, March 1951, page 98. The name of the article is. Water Fluori-
dation at Charlotte, N. C.
This begins with :
While April 1, 1949—
1 remind you this is April Fool's Day I am referring to, and that it was
chosen with premeditation, which I assert here as opinion — and I am
sorry to say w ith giggles — by men on the public payroll :
While April 1, 1949, was proclaimed as •'Fluoridation Day" by the mayor, and
a public ceremony was held at the lilter plant, at which time the chemical feeder
was started, the actual application of sodium fluoride was deliberately delayed
until April 25. This period between April 1 and 25 led one Charleston, S. C,
newspaper to editorialize on "Fluorinization" due to the fact that Charlotte
newspapers had been giving wide publicity to the literally dozens of complaints
which had poured into the health and water departments daily concerning
killing of goldfish, horrible taste, ruined photographer's films, stained laundry,
and so forth.
Now comes a sentence — and this is interpolated — which ends with
an exclamation point. A scientific article. There are two sentences
here, one following the other, which betray the frame of mind of the
author of the paper, if you please, jSIr. Cliairman.
These and many more undesirables were attributed to fluoride. At the height
of public reaction the press sought to correct false impressions by announcing
that up to that time no fluoride had been added to the water. Then without
further announcement fluoridation was immediately begun and no further com-
plaints were received for about a week, when suddenly the entire ice manufac-
turing industry reported —
and so on and so on. Just a lot of armchair chemistry follows, and
it is not of any importance to you, Mr. Chairman, or to me. This has
nothing whatever to do with chemistry.
This wildly uncontrolled experiment upon unconsenting and imin-
formed human beings has absolutely nothing whatever to do either
200 FLUORIDATION OF WAf Efi
with the private practice of dentistry or of medicine or with public-
health medicine, preventive or otherwise. I make it as a flat state-
ment, and I am prepared to adduce proof by the simplest of mathe-
matical means, simple arithmetic.
It is hard for a man who has conducted himself honestly in the
practice of dentistry for as many years as I have to read that and
remain undisturbed, but I am told by our erstwhile friends in public
health in the United States Public Health Service — which I want to
distinctly differentiate from the employees of those services in all
that I say today. I want to make the distinct differentiation between
those institutions which when their doors are closed at night remain
just piles of stone and the men who inhabit those offices.
It is a very hard thing for a man who engaged in the practice of
dentistry to have to listen to what we have heard, Mr. Chairman. I
have just read you an excerpt which is supposed to conamand the
admiration of a practicing dentist. I call it the chemical rape of
Charlotte, N. C., carried out by premeditation and deceit, using
coercion and ridicule as an instrumentality for the attainment of
illegal ends on April Fool's Day, with a possible allusion to collusive
conspiracy with the press, dependent upon the answer as to whether
the press in receiving this flood of complaints had knowledge that
the process had been deceitfully and in contradiction of warranty —
given tliose people when they attended the hearings — withdrawn.
An attempt to remedy this situation, which I have given in this
brief time only to a small ]3ortion, we went first to our professional
societies with diligence. Within 24 hours I prepared a protest against
these arbitrary moves on the part of men who by the most severe
overreaching of authority supposed that they could induct me and my
family and my patients into a course of medical experimentation with
the most disreputable poison in the whole list of commercial catalogs,
and then moving on from the professional societies with only negative
results and in some cases ridicule were obtained, a new experience
to me, I ask you to believe in the whole of my professional life.
We moved to the people. We went to the grassroots. We found
those large gryppers who pick up the minnows, the joiners, the
country clubbers were all engaged in advance. They had been pre-
empted. We couldn't reach them. So we went to the grass roots.
When you scoop around in the grassroots what do you get? There
are different answers. You get America. That has been my expe-
rience, and I am ashamed of none of it.
We then went to the executive department of the local govern-
ment and State government. Having exhausted our resources, not
having obtained satisfaction or a reply in many cases, we went to
the legislative. We recently had six bills in there, which all have
been defeated for this term, the passage of any one of which would
have attached a statutory definition of criminal to the overt act of any
of those people involved in the arbitrary selection of unconsenting,
uninformed human beings for medical experimentation with fluorine
compounds.
We will be back in the Massachusetts Legislature. We went there
tlie first year with one bill, and that was put into what a highly placed
politic:!! elected officer of this State described to nie as a limbo for
])o]itica] hot potatoes. It was put into a recess study commission.
FLUORIDATION OF WATER 201
I think, quite to the discomfiture of the initiators and conductors of
the fluorine experiment, when it had apparently been disposed of in
that way we came up with five more bills. I think we can go ahead
by geometric progression each year until somebody who is subjected
to tlie osmosis of fluorine, as unfortunately our friends here in
Washington are, will give us a fortright response.
It is a peculiar circumstance to have the formal invitation of this
committee to a city where the very routine of which we complain is a
condition for us to bear the precedent to our acceptance of youi-
invitation,
I ask you. Would it not be reasonable to call for a change of venue in
such a case? I certainly wouldn't drink that stuff. I certainly would
not permit any of my people, over whom I have control, to drink it.
But this is a minor matter, gentlemen. Everyone in this room has
gone to high school, and when he was in high school he learned about
osmosis.
Osmosis is a physical principle which is ruled over not by this or
that party but instead is ruled over by the Creator of the universe
whose existence I admit without fear or shame.
When anyone gets in a bathtub in Washington he is separated from
the water in the bathtub by a permeable membrane, which is a portion
of the definition of the physical principle of osmosis.
In osmosis we have the passage of liquids through permeable mem-
branes from the liquid of lower concentration on one side of the
membrane, through the membrane into the liquid of gi'eater concen-
tration on the other side. Recently I think I have compelled the
admission of one of the principal initiators, a former dean of Harvard
Dental School, in a Boston newspaper of the fact of physics, attested
by the Creator of the universe who observes that he is as much bound
by the laws of that court which he has set up as is the head of any
man-instituted court.
We have the admission that fluorine in the form of sodium fluoride
or sodium silico-fluoride, and all the rest of the whole silly list is
absorbable by the human body from water used in washing.
My time has run out I sense.
I wish to say this without giving offense to this committee, Mr.
Chairman. I regard this committee as friends. The noble senti-
ments expressed by the chairman for my dear friend. Dr. Robert J. H.
Mick, of Laurel Springs, N. J., who is now in the service of his
country, were appreciated. They turned my mind from hostility to
the chairman of this committee, which was unwarranted if there wtus
any in my heart, to complete admiration.
I am convinced of the fairness of this committee because they
are all Americans, Mr, Chairman. But if I can say it without offense,
Mr. Chairman and gentlemen, don't soak your bodies in W^ashington
bathwater because if you do the inevitable effects of the operation of
the laws of physics will come upon you. I am safe in Springfield.
I think I can stake my reputation on it. We will never have this
experiment performed on us in Springfield.
I think it is almost a certainty at the present time that unless this
is halted hj gentlemen who become interested in it it will result in
open violence in many places at once and provide that little spark
which the professors in Harvard (iradiiate School of Business Admin-
istration talk about in their private talks to their alumni.
202 FLUORIDATION OF WATER
I hope it is not offensive to you, Mr. Chairman, for me to say that.
I have tried to illustrate by a few words of humility which come from
the heart — just don't bathe in it for your own preservation, and the
preservation of your services to your country which we value. I say
it with the greatest sincerity. If I have exceeded the proper limits of
witnesses' testimony, I beg to be excused.
The Chairman. Doctor, we appreciate the sincerity with which
you have spoken and the strong convictions which you have with
respect to this matter. I also appreciate the admonition which has
been extended to the members of Congress and all other people in the
dangers they face. I have been here 26 years. I wish I could have
had that advice in the beginning. Maybe I could have lived even
longer than I will.
Dr. Manning. I think an answer is not in order. It is only an
observation. The process has been there only during a short period,
sir.
The Chairman. During what time? For how long?
Dr. Manning. I think only 2 or 3 years. It was put in here about
1951, but that is not for record. We could look it up.
]Mr. Heselton. I want to say Dr. INIanning is a neighbor of mine.
You have come with an admonition, and I am considerablj^ puzzled at
whether I am to remain unwashed during this hot weather.
Mr. Hale. Will the gentleman have to go to Springfield to bathe ?
Dr. Manning. It is a fine thing to do and we invite you most sin-
cerely and we will drink spring water in Washington when it is
obtainable.
To answer Representative Heselton, this is the type of a practical
question which brings the truth out about this, and our only lack
has been that the men to whome we have gone in industry have said,
"We are too big for it. We cannot touch it."
Within 24 hours I talked to a number of men wdio in their estimation
think they are substantial businessmen, and I think they are very
substantial businessmen, who say "I couldn't touch that with a 10-
foot pole."
But it is the type of question which my IMassachusetts friend has
asked which will bring out the truth about this. It has been said in
connection with that kind of question before now that we are trying
to get along with our friends, but it has been noticeable to you gentle-
men sitting at that desk. There has been no word of communication
passed between us who are in favor of House Resolution 2341 and
those public-health servants who are now attending the meeting.
There is no intercourse whatever there. There is no exchange of
opinion.
There is much in the prepared statement I have given along with an
equal number of copies of two standard newspapers from Massachu-
setts, the Standard Times, of New Bedford, and the Springfield
Union, of Springfield, Mass., which wull illustrate the contentiousness
which now arises.
The answer, sir, if I may speak through the Chair, is that I have
been here 2 days. I would no more soak my body in a solution of
sodium fluoride knowing my — I might be tricked into it— I am very
sure that the people in some of these cities which are in the records,
and I would describe them to you in detail if I could, I am sure many
FLUORIDATION OF WATER 203
people have done so unknowingly, but getting into a tub of it know-
ingly, no, sir.
Mr. Heseltox. Have you asked that your full statement be made
part of the record?
Dr. ^Manning. I have the statements here.
The Chairman. I want~to call attention to the fact that the custom
of this conunittee permits the witness to have his statement in full
recorded in the testimony, and that will be done in your case as well,
doctor.
(The statement is as follows :)
[Copy No. 50]
Statejient by Paui. Manning in Si ppokt of H. R. .1341, A Bnx To Protect the
Public Health From the Dangers of Fluokination of Water
Note.— Paul Manning, D. M. D. (Harvaid T'niversity. 1913 as of 1912) ; LL. B.
(Noi'tbeastern University, 1929), is a practicinj^- dentist and a consultant in
physiological chemistry. Fie holds certificates of registration in dentistry from
Massachusetts (No. 32(>S of November 13, 1913) and California (No. 2758 of
December 13, 1913). He became a life member of Valley District Dental Society
and of Massachusetts Dental Society in 19.^A), and through them holds member-
ship in the American Dental Association.
Dr. Manning is the investigator and author of Electrobiolytic Theory of Dental
Caries (published in Dental Cosmos (later merged with .T. A. D. A.) in LX, 1,
pp. 2G-30. .January 1018: LXI, 1. pp. 21-27, January 1919; LXXII. 4, pp. 3.51-357,
April 1930). The papers cited are believed to represent, as noted editorially in
the New York Times. October 2. 1949, page 8E. colunni 6, how "the writer * * *
a practicing dentist * * * in articles in Dental Cosmos, in 1918 and subsequently,
originally revealed the basis upon which iluorine effect is olitained."
In 1944 he began the study known as Research 44 : The Philosophy of Medical
and Chemical Experimentation on Human Beings. In 1949 he organized and
has since maintained the information-gathering alliance knov/n as Research 44
Associates, a cooperating group of American citizens who as volunteers conduct
independent, lawful inquiries at iirivate expense and who are agreed to continue
to do so at least until the ordinary media of news interchange at the national
level resume t!!os:> essential functions which now appear to be either neglected
or willfully set aside.
Preliminary statement
This is a petition by Paul Manning, a practicing dentist and chemist engaged
in studies on the philosophy of medicine, on behalf of his family, his patients,
and himself, to the Congress, throuuh the Committee on Interstate and Foreign
Commerce, to denounce and to' prohibit with aitpropriate penalties, those overt
acts of administrators and other emiiloycc's of the puldic-healtb services com-
prised under the fanciful and nondescriptive title of "Fluoridation of Public
Water Supplies."
Leave is asked also of the committee to represent such persons as. having seen
(;r heard, and reflected upon, this statement, shall state to the conunittee that
they regard themselves as the voluntary and unpaid associates of Research 44
and request the conunittee to record them as being in support of this statement
iiudof H. R. 2341.
Tile question
"Wide is the gate and broad the way" by which the (piestion posed liy H. R.
2341 rode into the peace and (piiet of this Nation — whether Congress shall sup-
port or prohiliit the exploitation, liy aliirmative overt acts of private doctors or
civil servants, oflicinls oi- others, of experiments, tests or trials, of medication,
treatment, "supplementation." "nutrition." or other feeding of uninformed, or
of unconsenting. human subjects, or of total populations of water-supply areas
with fluorine compounds, including sueh impurities as are always, and without
exception, present in those compounds as used.
The list of subordinate questions is very long, as we shall see.
48301 — 54-
204 FLUORIDATION OF WATER
The facts
Outwardly, the prophets of coUectivist mass medication who initiate, conduct,
and engage in massive medical experimental research and treatment on "the
masses" of free American human beings, proposed, to quote them, a "boon for
little children," which "could not be obtained in any other way."
Inwardly, the inventors, planners, initiators, conductors and those who engaged
in experiments, tests, trials, or treatment, or all of them, upon unwitting, un-
consenting human subjects, for money, power to dominate their fellow men,
or other undisclosed source of motivation, knew well, or could and therefore
should have known, that both their major claims were false and could be shown
to be false by clear mathematical proof.
If the foundation claims of the ofBcial fluorine therapists are found to be false,
as claimed herein, it will be clear that the overt acts of the responsible officials
constitute trespasses ab initio upon grounds of authority and upon physical
grounds where these officials had no legal right to enter, and this being so, all
subsequent acts of theirs were and are illegal, and this is left to the committee to
find upon receipt of proof, and to seek to provide protection for us as petitioned.
If a sheriff in serving a writ commits an illegal act such as an unlawful
entrance upon real property, e. g., and thereby invalidates all subsequent pro-
ceedings in that action, by reason of his trespass ab initio, then surely no reason-
able person will hold an unconsented entrance into the human body itself to
be otherwise, nor an entry into a human body with agencies or instrumentalities
which have been incompletely or fraudulently represented, or with agencies
represented to be "harmless when taken as directed," or with agencies repre-
sented to be harmful but only to a minor number of persons whose bodily privacy
is invaded.
The whole tenor and substance of what we offer as fact, as hearsay believed
reliable and as opinion based upon study, will show that the arbitrary "selection"
of human beings to serve as experimental subjects of fluorine research and treat-
ment, with which we have been repeatedly threatened, under color of authority
by USPHS employees, and by other public health servants who "follow the same
line," for more than .5 years, is a trespass ab initio, for which purpose I will offer
accounts of overt acts premeditated and carried out by public health employees
at Charlotte, N. C, at Newburgh, N. Y., and elsewhere, and published by them-
selves in proof.
The first major claim of the fluorine therapists, by which term is meant,
throughout, the protagonists of fluorine for all via the medium of the public water
supply — that metallic salts of fluorine, such as fluoride of the metal sodium,
taken several times daily in random 24-hour dosage are a "boon to little children,"
has been disproved by the fact that dentists themselves "chose to stay away from
the show in overwhelming numbers." This fact was disclosed by a survey of
homes of dentists over a nationwide extent, made by petitioner, and reported by
him in part to his district dental society in November 1950, and upon finding that
the members of the society were unwilling to hear the details and incuriovis as to
how the facts were gathered or as to the extent of the survey, it was published
in the Springfield Union, January 24, 1951. Leave to incoi-porate same by refer-
ence is reauested, with one copy attached.
The second major claim of the fluorine therapy's initiators, that "there is no
other way" in which the patient (or the human subject as we may call him if it
offends the finer sensibilities of the fluorine therapists to use the term "patient"
and so disclose that they have been unable to "clear" a subterfuge term such as
the word "supplementation" which they have been using as a noun to avoid terms
.such as "medication," "chemicalization," and "bodily assault") can safely obtain
(sodium) floride than by the method of intake with every drink of water is so
absurd a falsehood as to preclude all sober discussion were it not that it is also
so truly a Stalinesque-Hitlerian lie that it has fooled a large number of otherwise
respectable i>eople. However, this falsehood has been exploded by the principal
initiator himself, the Surgeon General of the United States Public Health Service,
upon the account by Hon. Alfred Lewis Miller in Congressional Record of
March 24, 1952, page 2805, column 1, paragraph 4, lines 13 to 16 :
"* * * j^n^ Y)Y Scheele of the United States Public Health Service, says he
gives it to his children in tablet form."
Petitioner holds a letter from a retired teacher in Pennsylvania, containing a
contradiction of the quotation above attributed to the Surgeon General of USPHS,
in answer to an inquiry of August 30, 1951, to USPHS, reported as follows :
"8. Can sodium fluoride be secured by prescription from dentists or physicians
for individual use?"
FLUORIDATION OF WATER 205
Copy of a reply from DSPHS dated September 5, 1951, is as follows :
•'8. There is no safe way whereby the sodium fluoride salt can be used by an
individual regardless of the method of procurement." The copy says the letter
was signed, "Sincerely yours, Thomas L. Hagan, Dental Director, Acting Chief,
Division of Dental Public Health." There is no mention of the po.sition held,
believed to be that of major general.
Subsequent written communication from our informant shows informant was
in fear of possible reprisals, for having made the inquiry ; this being the attitude
of a large number of people in many parts of the Nation after they have received
fi-om USPHS offices statemenfs of propaganda which directly deny the sense
of their inquiries.
While it is recognized that isolated instances of irrelevant response by Gov-
ernment officials to pleas for protection and forbearance, with re:;ard to citizens'
having to imdergo a known pointless course of medication internally and doctored
bathing, might be due to lack of ordinary understanding, or to mistake, on the
part of public health officials, the number and kind of returns received by in-
quirers at USPHS doors is such as to establish the suspicion, in the minds of
the receivers of that type of irrelevant reply, that USPHS servants are not so
much interested in the general welfare as they are bent upon fastening their
momentary medical enthusiasms upon their subjects come what may.
That such an attitude on the part of civil servants has precipitated a state of
grave internal dissension throughout the Nation, bordering upon outbreaks of
open violence, has been our observation over many months past, and this dis-
content is observed to be increasing, steadily, as events in San Diego and Boston,
in Portland, Greg., and in Birmingham, and points between, will illustrate when
they are investigated.
It is axiomatic that the committee is interested in stopping practices which
tend to disturb the faith and confidence of the American citizen in his form of
government; however, it is easily ascertainable by any serious inquirer who
is willing to take the time and trouble to sample sentiment widely throughout
the Nation that the greatest force applied to our people to compel them to drink
sodium fluoride solutions, to eat food prepared in those solutions, to undergo ab-
sorption of sodium fluoride by dialysis in their baths, and to carry the so-called
health measure to the ridiculous extreme of having to wash their underwear
and their overalls in what they and we and certain moral food-products manu-
facturers regard as a filthy mixture, and are certain comprises a dilution of a
concentratable deadly mixture, is pi'oducing a disrespect for institutions which
are inseparable from our Government and which reflect therefore upon our form
of government whatever consequences of their overt acts the civil servants of
"public health" induce.
Whether we take the reply of the civil servant in USPHS as reported, as a
denial that there is any way in which sodium fluoride can be safely used by the
individual regardless of the method of procurement, which certainly would in-
clude the fluorine-for-all method via the spigot, or whether we regard the re-
ported reply in the light of Major General Hagan's complete record as a principal
initiator of the fluorine exiierimental research and treatment, and consider that
he did not mean what he said, but meant instead that he was determined to fol-
low orders he had received to push the fluorine-for-all impressment program at
all hazards — an adjustment of his reported rhetoric which we would be very
glad to make in the purported copy of his letter — in either case his statement
contradicts that of the Surgeon General of USPHS.
The latter's reported admission that children in his home are fed sodium
fluoride in tablet form daily could be true, it is entirely possible ; whereas the
former's denial of all hitherto-recognized therapeutic means of administering
sodium fluoride could not be true, as to which proof is offered ; nor could his
reported statement after adjustment of the rhetoric, to make it mean what his
acts say he meant in fact, be true.
The time is ripe, or overripe, to call a halt to United States Public Health
employees' insolences, false statements, illicit claims of right, seci'ecies, and dis-
claims of personal liability for all the damage resulting from their having alone
set in motion the wildly uncontrolled train of damaging overt acts to enforce
fluorine therapy upon all living persons.
The USPHS emi^loyees, major generals, brigadiers, colonels, lieutenant colonels,
majors, captains, and small fry stand estopped, and all others stand estopped
from claiming that sodium fluoride is incapaliie of being administered b^
graded dosage. It is believe to be a matter for the United States Attorney
•General to investigate the repeated false assertions of those Government em-
206 FLUORIDATION OF WATER
ployees and of all those persons whom they in the exercise of their conclusively
presumed superior knowledge persuaded to parrot their censored falsification of
information, to determine once and for all the corrupt motivation which actuates
those falsifiers, and to take appropriate punitive steps, and I petition you to
place the matter before the Attorney General for that purpose, now and before
the people of this Nation are more greatly angered.
If those well-established standards of law, of conduct and manner, accumulated
by tradition and custom, and spontaneously occurring in new and succeeding
generations of just and moral doctors, have remained relatively untested in law
until recent years, it may be inferred respectably that this is because it was
not until near the midcentury that doctors attained such weighty governmental
positions as would, it now appears, provide the opportunity and create the
temptation for the most highly placed of those state doctors to discard those
tenets of moral legality which had theretofore prevailed, and to substitute for
them a set of new principles based upon purely materialistic considerations, and
excluding what had been considered, prior to that time, superior standards for
appraisal of "public" health adventures (Double Standards in Medicine: Moral
LegaUfy and Law Added to Technoloyij v. Moral Legality and Law Rejected).
Following one set of obligatory studies of drugs and of experimental medical
routines by which those drugs are proposed for commercial exploitation, we find
men whose thought processes run in planes explored and inhabited (because he
found them suitable for human tenancy) l)y the late Dr. Robert A. :dillikan, who
the more he explored the science of physics the more he became assured of the
worth of the person, in the light of the inevitablity of a Supreme Being.
Under another arrangement of presumed essential studies, to explore "science"
while at the same time suggesting no moral obligations to curb excess of "scien-
tific" zeal, we find men with pretensions to power over the mental processes of
their fellow men, like Trofim D. Lysenko of the Academy of Science in the Soviet
Union, who hold that the state is not only the proprietor of the mind and body of
each individual who composes the state, but also the manager of his current
opinion. Such men do n.tt hesitate to alter the groundwork of their • scientific"
proofs when the executive heads of state require certain conclusions inconsistent
with (luantitative proof.
It is common among such emotional and nonscientific "scientists" as I^ysenko,
to accuse all who differ from their ofliicial conclusions, of "emotionalism," so
that this routine Communist trick-technique provides a signal point for the
differential diagnosis by which a Marxian dialectic materialist, especially one
who has been deeply indoctrinated in Soviet activism, can be spotted from afar.
May I recommend to the committee the use of this diagnostic sign, with
assurances that whatever man decries the normal human emotions as unworthy
or dishonorable, or who regards them as a signal for attack, is himself the
enemy of humanity, for without emotions there would not be a single human
being' alive on this planet today; again I say this line of diagnosis, with other
tested means at our disposal will identify the enemies of the American state,
whether in Government employ Or outside it. And the value of the diagnostic
sign is more than doubled when in the course of uttering the cry "emotional"
the subject or suspected individual is himself engaged in an emotional appeal,
the (luality of which can be determined by logic. In case of uncertainty as to
how this inf(n-mation applies, we have the names of proselytes of the fluorine
experiment who have used this line of attack upon our peace and security
repeatedly, and over the widest area, indicating that pattern which will become
evident as the matter unfolds, of concerted action by more than two individuals
to cause, if possible, the American freeman to distrust his own normal mentality
and to place trust in planned propaganda which he at the outset regards a.s
corrupt and against his interest, and to cause or to lead him to submit to medical
experimental routines which he in the possession of his normal mental faculties,,
when not brainwashed by mercenary propagandists would reject.
Under the first set of conditions, where problems of moral legality and of law
are held paramount in the public interest, we find men looking for the following
satisfactions of minimal recpiirements for the commercial exploitation of drugs
and treatment methods, in the order named, from 1 to 5.
This order must be applied to every new medical routine applicable either to
individuals or to the public en masse, at the beginning of the period of proof of
a drug or medical routine, or at the time of its investigation to determine whether
it is suitable, under the means and methods proposed, for use in human medicine :
1. The ethical requirements: What are the facts of public morality V Which
is to ask, what is the moral legality of the use of the drug or medical routine?
FLUORIDATION OF WATER 207
2. Requirements of man-made law: What bearint;' have the statutes? As,
Shall the statutes forbidding pollution of public water supiUies l)e vacated iu-
fornially by administrative edicts'.' Wliat is the aiiplication of civil and criminal
law, in the li.iiht of the moral law which underlies all formalized law? (Note:
Here attempts to enter the dialectic materialist, l).v sidelong approach, having
ignored all prior obstacles and safeguards.)
3. The facts of chemistry. Stability, compatibility, uniformity, purity, action,
etc. Unless this hurdle is passed without kicking it over, the medical racer is
disqualified, as with prior hurdles.
4. The medical facts. Nearly, but not quite the last hurdle, this includes
si>ecial medical, su<-h as dental medical, facts.
5. The economics of drug administration, including costs and management
routines, comparatively with other methods, etc. Enthusiasts of one method
Lave been heard to declare that other methods eitlier do not exist, or are defective,
or are immeasurably nmre costl.v, or are unsafe, or may residt in lower sales for
the enthusiasts : for example, all the foregoing examples of trade-jealousy, com-
mon alike to the snake-medicine peddler and to the shills who threaten and
abuse peaceable people in an effort to compel them to submit to the sodium
fluoride iieauty treatment, have been exhibited by the professional promoters of
forced fluorine for all, in the exploit called "fluoridation of public water supplies."
Firxt ihing>t first in. mcdivlne
It must l)e clear that the foregoing considerations, in their proper order, form
a series of hurdles, each of which, within the rules against upsetting them, must
be passed in turn, in order to obtain approval for any new drug or medical
routine.
Would we say, for example, that merely because a drug or other medical routine
is cheap, every person must submit to drinking it, eating it. and bathing in it — .
where he will certainl.v absorb it by the dialysis which occurs in the operation
of the physical principle of osmosis? No, but even before that question arises
there are prior hurdles to be passed cleanly.
Or would we say that because, being cheap, we can pass from the last
hurdle, at the end of the path, in the wrong direction, toward the starting place,
and require all persons, or a single individual, to submit to treatment with any
drug or medical routine, "if it promises possible. prol)able, or sure results,"
merely because it is cheap or we "guarantee" its effectiveness upon some of our
proposed subjects, or because we, as interested parties, claim we know of no
harm which will ensue, or because it has been pronounced "i ood" or a "boon to
mankind," or "the greatest health measure since I'asteur," by an executive of
government?
That is the position of the fluorine-for-all entlmsiasts, as a matter of record,
not at all difficult to show.
Intnidrrs: The didlectic materialists of niidcvHtunj "public" medicine
At this point, as we retrace the littered jmth of broken hurdles, we see tearing
into the course from the left side, between hurdles 2 and 3, a horde of dialectic
materialists headed for hurdles 3, 4, and 5, who are apparently unmindful that
the wind of their passage has knocked down hurdles 1 and 2, the existence of
which these athletes have pretended to ignore. If anyone can find any remnant
of mural philosophy, in the USPHS propaganda for forced fluorine feeding, for
the objects of those civil servants' philanthropic dutch treats, a very large number
of American freemen would like to have notice of it.
What we, who wish to administer our own materia raedica and treatment,
have not been able to make understood by polite requests to be let alone is the
evident difference between orderly and decent competition for professional
reputation which we practice and enjoy, and the forcible methods of the Gov-
ernment-employed fluorine therapists. We would not for a moment consider
carrying out an experimental routine, without first having given all the informa-
tion we possess, and a description of the hazards reasonably to be expected, and
having awaited respectfully the consent — or refusal — of the proposed experi-
mental human subject.
It does not seem to penetrate what appear to us to be shunt-wound intellects
that this late entrance into the race, in disregard of the hurdles of established
morality and law, has disqualified such competitors for public favor from orderly
and decent competition forever thereafter.
Our case is quite different from that of athletes, who when disqualified may
he reinstated after a time of good behavior. In science it is quite otherwise.
208 FLUORIDATION OF WATER
l)ec:uise science is not a mere jrame to ''get there first." but only a search for the
truth.
In science one who has been found guilty of having but once knowingly taken
"a part for the whole" (as in the assumption that the human body is nourished
by impurities in drinking water) or of having wantonly violated any other
axiom, or of having premeditated! y tampered with his proof-material, is forever
ostracized from the company of scientists, he is forever regarded as being of un-
clean mind, and thereafter he would not be given a .iob as elevator boy in any
well-ordered laboratory, because the proprietors "would not care to have him
around."
In the massive fluorine experiments were "scientists" or at least men with pre-
tensions to the fringe of science, on public pay, promoting a medical adventure
about which they knew next lu nothing, and concerning which they showed the
greatest indifference to learn, who not only violated every precept of the ma-
terialistic sciences whose dialectics they professed in the most extravagant
language to adore, but who required the human objects of their socio-political
affections to believe, and to admit, that as privileged beings they, the employees
of the public health services, were exempt from all requirements to act under
the restraints of moral legality and law which are now and have been for many
centuries imposed upon the acts of ordinary men.
Nevertheless just and moral men everywhere, who initiate, conduct and engage
in medical experimentation or who expect to be invited to submit to it, will have
to examine all of these hurdles in order, attempting with full facts honestly as-
sembled to take each in its turn, and recognizing that to kick over just one of
them means disnualiflcation of the entire effort.
Tliis much may be said for those contestants who seek to originate novel or
original medical routines — and I know of no more hopeful excuse for them than
that they were imbued with discipline of a very high order and of martial type —
all may enter and try to win the medical races, and one may try as often as he
likes, so long as he observes the rules and does no injury to others or to the rights
of others.
But all must begin, even great governments, at hurdle No. 1, the barrier of
moral legality or ethics, which is the beginning now, and which always has been
and always will be the beginning of acts of license, of permissive use, of acts
for hire, and of acts of claimed authority, and if anybody who is entrenched in
a castle which he considers impregnable against retaliatory attack is so minded
to conduct forays upon the common heard "out in the field" from that vantage
point, be sure that with time the stones of that castle will be taken apart one by
(me, by men's hands if need be, and laid in disorder on the plain as a memorial
that barbarism is less worthy of man than is his intelligent conduct.
In the long run as well as in the immediate future, those medical enthusiasts
who try to sneak in upon the course of respectable medical progress by the
shinit-vvound route of the far left between obstacles Nos, 2 and 3, and thus
avoid answering to questions of moral legality and law, will find "their public"
unhappy about it.
The moral and legal limits of medical research and treatm,ent
"Therefore all things whatsoever ye would that men should do to you, do ye
even so to them : for this is the law and the prophets. — Matthew 7 : 12.
This is, or should be, the doctor's chart, compiled by the Best of Pilots.
Taken as a basis for more than one professional society's official code of
ethics, this good law is not an implied license, even though some men clearly con-
sider it to be one, to enter into the body of another for any purpose, lacking the
full informed consent of the proposed receiver of benefits.
Only under a distortion of the principle of totality, which is to say the prin-
ciple of totalitarianism, is there any license presumed to be implied to intermeddle
in the life, or tlie body, or with the mental faculties of a human being, in order
to effect a claimed "greatest good for the greatest number." Such an idea is
not without promoters today ; some or all of the importers of strange European
socio-political ideologies profess to know that the individual must be subjugated
to the state in all his being, in order that we may have progress.
To one experienced in observing the attempted swift encirclement of this
Nation with forced fluorine experimental research and treatment, it is uncertain
whether progress will come before bloodshed if the fluorine therapists continue
to press with hard obstinacy for meek submission to the totalitarian medicine
of fluoridation of public water supplies.
FLUORIDATION OF WATER 209
Whether we look at the Golden Rule as hedonistic teaching, as some have
claimed, and so force Thomas Jefferson, with his "pursuit of happiness" into
hedonistic mold, seems of less imp<irtance in the present emergency than to
consider the practical effects of dropping the Golden Rule from public-health
equipment. The present situation is not without precedent.
Recent effects of political control of medical research
"Do you regard as criminal, experimentation on human beings without their
consent V"
This is the question asked by United States Prosecutor James McHaney of
the leader of the medical profession under the National Socialist regime in the
medical trials before Tribunal No. 1 at Niirnberg. The accused was on trial
for crimes against humanity, as reported in Department of State i-ecords, and
in Doctors of Infamy, a translation of Das Diktat der Menschenverachtung
(Henry Schuman, Inc., New York, N. Y.), at pages 156-157.
The answer of the accused began, "It depends * * *" and from that point
in the trial his fate moved toward sentence of death by hanging.
The prisoner was further asked, "What difference does it make what type of
experiment it is, if the experimental subject has not consented to undergo
the experiment?"
"Defendaxt K B . You may well call it an experiment even
when it is only a matter of testing some newly introduced drug. There is the
conviction that it will be helpful, but the final knowledge is lacking. Even such
a thing can be called an experiment."
(The accused doctor referred to experiments on prisoners and mental patients,
adding — )
"There are three aggravating factors with respect to the question of the
criminal element in experiments : their involuntary character, the lack of neces-
sity for them, and the danger involved.
"Mr. McHaney. In other words, you find situations where it is possible,
although the experimental subject does not volunteer, that nonetheless the experi-
ment is permissible, both by way of law and morals? Is that right?
"Defendant. Both may be possible ; yes.
"Mr. McHaney. You are a doctor. I should think that you ai-e probably rather
familiar with malpractice cases and statutes in Germany. Suppose, Herr
B , you tried out a new drug on one of your patients in prewar Germany,
without telling the subject about it or asking his consent in any way, and as
a result the person were injured by this drug. Would you or would you not
be subject to a charge of malpractice?
"Defendant. I should certainly have risked such a charge.
"Mr. McHaney. Well, then, I don't quite understand the situation in which
you say it is permissible to do something to a person without his consent.
"Defendant. That is why I made the distinction just now, because it is
essentially a question of degree of dange' And what you have just said implies
an aggravated danger, because lack <•♦ >tnsent is added. To my mind this
would constitute double aggravation, and if the experiments should also be
nonessential, then the ultimate degi-ee of aggravation would have been reached."
(The court proceeded to alleviate the position into which tlie defendant had
placed himself by his damaging admissions against interest. The prisoner was
eventually hanged in accordance with sentence imposed by the fc>ur United States
judges of the tribunal. Like sentence was also executed on a doctor who had
formerly headed the German Red Cross, and on two other physicians, as well as
a trio of their lackeys. ■>
Let us see what was happening in the United States in the same years, toward
the time when the physical and mental powers of the President were waning,
when he no longer exercised a restraining hand on many of the vast govern-
mental enterprises institutetl in his long term of influence.
In Water & Sewage Works (155 East 44th Street, New York 17, N. Y.) 98:3,
March 1951, pages 98-102, is the account "Water Fluoridation at Charlotte,
N. C." which with other similar accounts illustrates the status of the fluorine
experiment.
"While April 1, 1949 was proclaimed as fluoridation day by the mayor, and a
public ceremony was held at the filter plant, at which time the chemical feeder
was started, the actual application of sodium fluoride was deliberately ^ delayed *
until April 25. " "
^ Admission that an act of deception was premeditated for April Fools' Day, and that
this was deliberate, i. e.. for a purpose.
* Representations made with unusual formality admitted falsely made.
* Was this a planned and premeditated period? For what purpose?
210 FLUORIDATION OF WATER
"Charlotte newspapers had .uiven ^ wide pulilirity to the literally'^ dozens of
comphTints which had poured into health an'd water departments daily "^ concern-
ing killed goldtish, horrible tastes, ruined photo.iirapher's iiluis, stained laundry,
etc' These and many more" undesirables were attributed to fluoride." At the
height of the reaction " the press suught to correct false impressions " by
announcing ^" that up to that time no fluoride had been added to the water 1"
"Then, without further announcement " fluoridation was immediately begun "
and no further complaints were received " for about a week when suddenly
the entire ice manufacturing industry reported a severe increase in cracking
and shattering of manufactured ice."
The remaining details can await formal investigation, no si,gn of whicli has
"been forthcoming from those law-enforcement agencies charged with detection
and punishment of fraud and violence, in the •"> years which have elapsed.
The questions to be asked concerning the points of reporting marked with
footnote numbers will occur to any lawyer with experience in criminal trials.
In general, did the chemical rape of Charlotte on April Fools' Day, 1949, by
coercion through ridicule, advance the cause of "science" or produce a net benefit
for Charlotte's people, even upon the nonhedonistic basis of dialectic materialism
or in the totality of arranged Marxian socio-political change or on any other basis
known to you?
From Holyoke (Mass.) Transcript-Telegram, March 1951:
"Newburgh Study Shows Problems in Fluoridation."
Following a list of "ridiculous" complaints, ascribed to Newburgh citizens, the
prepared article says :
"After letting these arguments build up for several months, health officials
knocked them down with one devastating answer :
"No fluorine has yet been introduced into the city's water supply.
"As a result of this strategy, there was no adverse reaction when the injection
of fluorine actually began on May 2, 194.5."
From Easton (Pa.) Express of March 31, 1954, a Martinsburg, W. Va., dispatch
by the Associated Press :
"The city of Martinsburg took advantage of human nature when beginning
flu,oridation of its water supply. To avoid complaints from persons imagining
a new taste or odor in the water, officials withheld for 1 week the announcement
that fluorides had been added. There were no complaints."
(Do you regard as crinflnal experimentation on human beings without their
consent? Would this have been an experiment in brain-washing opinions out of
Martinsburg heads? Would this be an incitement to riot?)
From Boston Post, April :}(). 1953 :
"Two Cities Unknowingly Use Fluoridated Water."
"Residents of Salem and Beverly have been drinking fluoridated water since
December 7 without knowing it, it was disclosed yesterday.
"Mayor Francis X. Collins, of Salem, him.self, did not know that the water
he drank each day had been treated until February, 2 months after the experi-
ment got u,nder way. However, he went along with the responsible officials in
maintaining secrecy.
"He declared yesterday that the information was withheld from the public
to avoid 'crank protests' which might preclude a fair test of the public reaction
to fluoridation."
•* Does the reporter accuse the newspapers of collusion or conspiracy?
^ What was the number? Are the original records available and if so produce them.
« Assertion of "literally dozens daily." of complaints. Verify.
' Name the others represented by "etc."
^ What ones were "many more"?
* Were they rightly or wrongly "attributed" in view of the physical effect on freezing
water? How prove? And if no nroof. is ridicule reasonable and prudent?
^'' How is a current reaction judged to be "at its height," otherwise than by planning
an incitement.
■11 What false impressions as to fraud: as to taste of water; as to "etc.": as to what
was to cdme
'"Who instigated the announcement and with what future overt acts in mind?
^ Would this be a double deceit, a one-two punch, a putting of the common herd in
Its place?
'* Was withholding of "further announcement" part of the original plans? What do
you consider the legal liability for having set up an open ceremony for the public, with the
premeditated intention to deceive them on April Fools' Day, and then committing this
secret act ?
'^ Do you suppose that people once fooled, humiliated in public, derided and embarrassed,
would come to you again in hope of humane consideration?
FLUORIDATION OF WATER 211
(Witch City mass medication fooled the mayor, too? Why did he choose to
condone that series of overt acts? Are important numbers of Witch City people
"cranks," in the mayor's estimation? How far does "fairness" extend?
"And what you have just said implies an aggravated danger, because lack of
consent is added * * * quoted above from record of the medical trials. )
Add the large number of similar accounts of secret induction of human beings,
by arbitrary '•selection," to serve as subjects for medical experimentation and
treatment, as at Stevens Point, Wis., at Loujsville, Ky., Rhinelander, Wis.
(6 months of secrecy), Marshfield. Wis. (80 days of secrecy), and many others,
for an explanation of why the official German observer at the medical trials
of Nuremberg entitled his account "Das Diktat der Menschenverachtung," or
The Dictatorship of Contempt for Humanity.
From the record of the medical trials of Nuremberg (see Doctors of Infamy,
p. 17), quoting a letter from Heinrich Himmler to his "Dear Comrade Milch" in
NoA-ember 1942 :
"Let's not worry about the difficulties. It will take at least another 10 years
before we have rooted out this narrowminded approach from our people."
(Himmler is referring to freezing exi)eriments carried out on human beings — ■
without consent — ^"in the interests of the state," as well as to euthanasia experi-
ments to weed out those who for reasons of infirmity or age could no longer
replace the value of what they ate.)
From Dental Survey, published at Essex Building. Minneapolis 3, Minn., 28 : 1
(January) 1952 : page 27. "Fluoridation Slow."
"Dr. Knutson is irritated with the delay, but not discouraged. Regarding his
own estimate of 150 years to complete the job nationally, he says, 'Of course it
won't take that long. We won't let it take that long. I think it can and should
be finished within 5 years'."
(Both timetables were upset: the Nazi timetable with a comparatively liberal
allowance for "driving out the narrowminded approach" and the T'liited States
Public Health major generals' timetable "earmarking" one-half that time for a
vastly more grandiose conquest of the minds and bodies of free men.)
Matters for the committee to resolve, in the same way and u\K>n the same fac-
tual basis that large numbers of our people are resolving them in defense against
unprovoked and pointless assaults upon their right to privacy of their own bodies
and to the management and superintendence thereof, said assaults being prose-
cuted under the guise of claimed "health" measures called by the willfully and
admittedly false and fraudulent title of "fluoridation of piiblic water supplies."
(See p. 41; par. 4, etc.. Proceedings of Fourth Annual Conference, said to have
been a secret document of the United States Government's employes, an account
of a conspiracy to exercise dominion over the minds and bodies of free Amer-
icans. )
As far as the prescribed time for preparation of this statement allows, it is my
intention to provide the committee with a list of matters which seem to me to
require deep and thorough investigation, constituting "a long train of abuses and
usurpations, pursuing invariably the same object, which evince a design to reduce
us under absolute despotism," and at variance with the purposes for which the
United States Public Health Service was authorized in 1912 with powers granted
to "study and investigate the diseases of man and the conditions influencing the
propagation and spread thereof."
(Definition : "They," "them," and "their" — except where otherwise indicated —
shall relate to these antecedents; the instigators, initiators, and conductors of
massive fluorine experiments, tests, or trials upon arbitrarily "selected" unin-
formed or uncon.senting human subjects and like insolvent overt acts of the
"public health" regime. )
1. Whether they know that no chemical element can be utilized in human
nutrition without first having been passed through the plant barrier and whether
all animal life is walled off, and forever prevented, from obtaining nourishment
by eating clods of earth, or other inorganic elements or compounds which have
not first been passed through the barrier of plant life, and by photosynthe.sis
converted to edible and nutritious substances.
2. Whether this has been published to thein and to others by Manning and
others, repeatedly, and whether they paid proper attention to rhe iiisti-uction
and acted accordingly to forbear their misreiiresentations concerning fluorine as-
a proper nutrient, or whether they did not in fact invent new theories of nutri-
tion and, or, proceed with increased zeal to force the swift accomplishment of
their plans?
212 FLUORIDATION OF WATER
3. Whether the foregoing informatoiu is uot elementary and easily proved
without any special equipment ; whether Manning offered to direct such an
experiment — the subjects to be those informed and consenting oflacials who insist
that metallic salts of fluorine are proper additives to the human body, and the
subsistence of those subjects to be the entire range of chemical elements, in the
form of compounds of those elements, of U. S. P. grade of purity, plus ordinary
pure water, but without any of the produce of the soil or of seed production.
Whether the invitation was refused? or disregarded'? or whether they would
like to comment publicly with opportunity for confrontation and rebuttal?
4. Whether the mere absorption and incorporation by plants of mineriU ele-
ments is any guaranty that the elements so combined will not be poisonous or
deleterious, as, e. g., arsenic, lead, selenium, fluorine, and other plant-absorption,
the proper replies being well-lcnown to intelligent or charihuen and gardeners?
5. WTiether any known chemical substance is incapable of measured dosage,
and whether it has been the universal practice among doctors to adjust the
dosage of every medicine to the age ; weight ; lieigth ; sex ; condition of health
or disease; condition of growth: conflict with otlier medication and with food
and drink ; cyclic function in females and liability to wound-hazard with refer-
ence to clotting capacity of the blood: climate; hyther or the comparative
values of temperature and humidity as affecting metabolic lates ; avoidance of
known medicons or substances totaly worthless from a standpoint of medicine,
especially those having extensive criminal records as agents for homicide includ-
ing suicide; allergy or the departure from normal in reaction to a drug: a true,
safe, effective and ready antidote operable under a narrow range of tolerance
and without undesirable side efiects ; a definite knowledge of minimum lethal
dose per unit of body weight within a respectably narrow range of tolerance
upward and downward : sufficient knowledge of the natural history of the
disease being treated or prevented to enable the doctor to withdraw the medica-
tion when the object has ben reached and before unneeded results or toxicosis
occur, and other considerations?
6. Whether they (the initiators, etc., of the fluorine experiment) observed any
of those traditional and proved requirements, and so acted, or whether they
disregarded some or all of them, and why?
7. Whether they published the statement that "5 grams has caused death,"
by way of subterfuge, or otherwise, to satisfy dentists and others who relied on
them as Government servants? Whether they knew or could have known that
5 grams might liill a large number of people, or possibly kill 15 adult humanS
or had seen records of such conjecture in standard medical journals?
8. Whether they did not in fact word the statement (7) ambiguously ,in
loose terms never used by men of science, in order to confuse and to make more
difficult the formation of possibly adverse opinion of dentists and others?
Whether they intended to create the impression among dentists that "sodium
fluoride is safe," and did so publish, and/or cause to be published and whether
sodium fluoride is ever safe for human consumption or even for commercial
handling? Whether it is a known fact that all of the handlers of fluorine com-
pounds in water department sheds are and have been absorbing more fluorine
than they can eliminate since the start of the experiments?
9. Whether numerous collapses, otherwise unexplained, having been occurring
among child patients treated by dentists with topical sodium fluoride applica-
tions, and whether the USPHS employees have investigated those collapses,
in and out of dentists' ofiices, as recommended by Manning in 1951? Whether
they did or did not advise a Springfield dentist who had reported such a collapse
to Manning and who had agreed that a central clearinghouse for such informa-
tion was necessary to avoid disaster, to break his promise, to disregard a chart
form devised by Manning for that tentative purpose of collating such informa-
tion in the public interest; and did not the dentist obey their injunction to
remain silent and not to act, confer, or cooperate ; and did not Manning thereafter
cease to try to deal with the authors of what he regarded as a leglect of proper
professional conduct?
10. Do they not know that sodium fluoride 2-percent solutions and stronger
are used by dentists in spray bottles, for direct or topical applications to children's
teeth, in reliance on public health employees' statements, and that in a 4-ounce
spray bottle there are, at 2-percent concentration, 36 grains, or 2,332 milligrams,
of NaF? Whether Gettler & Ellerbrook, in A. J. M. Sc, 197: 625 (May), 1939,
recorded the indication that death of an adult human might result from the
absorption of as little as 105 milligrans of fluorine?
FLUORIDATION OF WATER 213
' Whether it is proper to lead dentists to the belief that sodium fluoride is
safe when reports that their 4-ounce bottles may contain enough fluorine to
kill several adults have never been disproved on any basis?
11. Whether there have been deatlis by suicide or other homicide from fluorine
compounds, as a direct I'esult of the needless, pointless, unjustifled publication
by officials of false information that fluorides are safe? How many? Where?
12. Whether their fluorine-for-all propaganda constitutes an open invitation
to s(mie psychotic individuals to commit criminal mischief?
lo. AA'hether there had been since about 1928 or 1929 a gentlemen's agreement
in our national news press that poisons when used for criminal mischief, such
as suicide and murder, would not be named in newspapers and periodicals, and
whether the press had not lived up to that agreement nearly 100 percent until
the advent of USPHS nationwide propagandization for mass medication with
fluorine?
Whether they in fact did not rely upon that known censorship, admitted by
all to be in the public interest, as a principal point of control of the press and
the jiress wire services, and whether they did not regard and try to use such
cooperation in censoring the miserable facts of all fluorine compounds' toxicity
as vital to the swift envelopment of the electorate in their scheme?
14. Whetlier when they had received timely warning of impending danger to
themselves as well as to the entire American public, they heeded that warning
as prudent men or whether they did not in fact retaliate with every means
within their power and with some outside the scope of their lawful authority,
such as incitement of rumors and the condonement of such rumors n^; accepted
public-health methodology, to the effect that their opposers in the raulis of the
professions and elsewhere were actuated by ulterior motives, such as inordinate
desire for iniblic notice and a<-claim, for money, for religious beliefs which the
context of those planted rumors showed the public officials held in greatest
disrespect? And had they not shortly before criticized publicly those professional
men who sought to warn them of the impropriety of their acts, by ])ublishing
critical analyses of those acts, under modest pseudonyms so as to avoid public-
preferment, for having written for publication under pen names?
Whether public health servants must always "tal^e their half out of tlie middle,"
or whether there; is any way to satisfy their greed for power to dominate their
fellow men?
Whether their refusal to accept either of two diametrically opposed positions,
as just described, both of which were designed to placate, but only enraged
them with their continued rude disregard for polite requests to let our patients
and ourselves alone and to leave us out of the orbit of their power, does not in
fact indicate that their desire is to incite and provoke open violence?
Whether the every word and act of fluorine activists in a very lart^e number
of cities does not suggest to the people they have put in fear, and against whom
they claim they have the present ability to carry out the acts they threaten and
which in many case's they have carried out, that the only possible working result
of those acts and words is a putting in fear and an incitement to breach of the
peace?
15. Whether they instigated, or condoned and accepted as reputable "public
health promotion," for which billions have been appropriated by recent Con-
gresses, the use of libelous terms, such as the "crackpot" publications of
Gerald Judy Cox, Ph. D., regarded liy many, and possibly by himself as a
principal initiator, and a one-time recipient of the bounty of Mellon fellow-
ships, in Pennsylvania Dental Journal, 17: 279 (Dec.) 1950, republished inter-
nationally by ADA in February 1951 and thereafter, and from there applied
orally in slanders and in uncounted printed libels over the widest areas, to
stifle and coerce into silence all reasoned opposition?
Repeat foregoing examination in the case of Shirley Dwyer, D. D. S., a party
to "Fourth Ajinual Conference." in re Manchester (N. H.) Union-Leader,
June 13, 1951. This public health officer refers to the parents and relatives
of the tender oiijects of his solicitude — when they disagree with him — as "the
group suffering from starvation of mental ability (that) always feels that the
other has something they envy and seek to detsroy. * * *"
Repeat examination as to the editor of JADA, the Journal of the American
Dental Association : whether he published the statement in the .iournal in their
defense, and whether the libel was republished in a newspaper charging that
the people themselves were "insane," and whether either the editor of JADA
or USPHS civil servants made any effort to deny or to mitigate tbi.> or other
214 FLUORIDATION OF WATER
similar continuing libels, evidenced in publications over the length and breadth
of the Nation?
Whether it is for such purposes the Congress grants $289 million for "Pro-
motion of public health," and what relation have libel, slander, and vituperation
to our health, in the estimation of the committee?
10. Whether they have seen and studied the published figures of Manning,
showing that all the children of the United States under sane regimen of graded
dosage could not possibly consume more than 100 pounds daily of fluorine as
sodium fluoride, even if they were given measured doses 10 times the amount of
tentative daily M. A. D. R. dosage for adults of any of the other "trace minerals"?
( See the Springfield Union, December 24, 1953, minority report of Massachusetts
Study Commission and two bills designed to define "fluoridation" as a criminal
act; reprint attached.)
17. Whether they have noted, studied, accepted, refused, or replied to Man-
ning's oiler to supply the raw material for 1 year's fluorine medication or "feed-
ing" for all children in the United States, as published in Mount Dora (Fla.)
Topic, July 24, 1952, and hereby withdrawn with an ofCer to renegotiate the
original offer directly with United States Public Health Service.
IS. Whether they have noted, studied, accepted as true, or rejected Man-
ning's appraisal of their "efficiency," based upon figures of their own "authori-
ties." Armstrong and Brekhus (in Journal, Dent. Res. 17 ; p. 27, 1938) . The differ-
ence in fluorine content reported therein to be 09 parts per million in the enamel
of "poor" teeth, and 111 parts per million in enamel of "good" teeth or a net
"deficiency" of 42 parts per million proposed to be added to presently poor
teeth to obtain good teeth, the difference to be made up by fluoridation of
public water supplies.
(Whether any explanation by United States Public Healtli Service is due,
concerning what their crystal ball reveals will happen to the bodies of "the
percentage of children" who are statictically recognized as destined for good
teeth, and for whom, by their own hypothesis, any medication is overmedication.)
(Note : In Granite State News, XC, 9 (March 2) 1951, Prof. R. S. Harris noted
that "spectrographic analyses have shown that many healthy teeth do not con-
tain fluorine," which refutes the entire hypothesis of fluoridation since if one
perfect tooth can be formed without any fluorine whatever, it follows that all
teeth can be perfect without fluorine.)
The basis for computing the actual quantity of fluorine, "laid down and in-
stalled on the job," and the proper cost of same, f. o. b. the chemical warehouse,
using the figures of Armstrong and Brekhus, was pviblished l)y Manning in Holy-
oke (Mass.) Trau-cript-Telegram, February 28, 1951, page 20, showing that in 1
year all of the cl ihlren of America, even granting that all had poor teeth, which
"is by no means true, although the United States Public Health Service work on
human experimental sulijects assumes it could utilize less than one-half pound
of elemental fluorine.
Basic facts needed for computation are :
Population of the United States, about 160 million.
Children of "fluoriuatable age" not over 25 ijercent of above, or 40 million.
Weight of enamel of adult teeth, plus 4 grams.
Added fluorine proposed, 42 parts per million.
Florine in sodimn fluoride, nineteen-forty-seconds of gross weight of NaF.
Grams in avoirdupois pound, 453.592.
Market price of NaF.
19. Whether in fact, with the utter loss of all controls such as might have
served for comparative findings had they been properly managed, the committee
will decide, or leave to the Attorney General, the degree of culpability of the
principals involved in the disgraceful episode recounted in the infantile language
of excuse and avoidance, at page 1500, paragraph 7, of part 3 of the select com-
mittee hearings (chemicals in food products, etc., 82d Cong., 2d sess.).
AVhether it was in fact true, as alleged under oath, that "They felt they wanted
the water fluoridated, so it is being fluoridated, and so we have lost it as a con-
trol. But we certainly want to go back each year and do reexaminations."
20. Who were the "they" who "felt" tliey wanted "tiudridatidn"? Who so
gentle in USPHS as to give in so readily to what "they felt"? Who will do the
reexaminations at Muskegon — and why? Surely not for the purpose of quantita-
tive measurements ; those are now rendered impossible throughout America, as
is well known to the social anthropologists ; then for what reason other than
dollars and domination?
FLUORIDATION OF WATER 215
21. Whether civil servants regard themselves as immune to personal liability
merely because they hold Government jobs?
Whether civil servants regard the billions of dollars, billions of v^^indmill words,
billions of lost labor-hours, invested by all parties in interest, as an achievement,
or as unconscionable waste?
22. Whether the intrusion of preventive medicine into water supply manage-
ment with 50,000 tons of sodium fluoride annually was a wise and prudent move
or a dangerous precedent?
23. Whether fluoridation is not in fact a three-pronged attack, gleefully watched
by the enemies of America :
1. To secure a legal precedent once more which was lost some centuries ago,
with prescriptive rights in and to the body of the citizen,
2. To obtain the therapeutic and toxicological effects, be they good or bad, of
the drug of choice, and
3. To divide the unity of our people in the most critical hour of our history?
24. Whether, even though the first two objects were halted, by passage of
H. R. 2341, the third prong of the fluorine assault has not struck deeply — -whether
this was foreseen at any stage of the attempt and by whom it was foreseen — and
with what proper action by him or them, if any?
25. Whether there is one single subversive or enemy agent or indoctrinated
fellow traveler who is not head over heels "in favor of fluoridation," as the ex-
pression goes? Whether this is because he has been ordered to endorse the
scheme?
26. Whether the storage of multiton lots of compounds of fluorine, the essen-
tial ingredient of the nerve gas which all nations fear but which several are
stockpiling, in ill-defended areas adjacent to main aqueducts of great water
supplies, is wise and prudent, or foolhardy and criminal to a degree never before
attained in history?
Respectfully submitted.
Paul Manning, D. M. D.
SUPPLEMENTART STATEMENT BY PAUL MaNXING, IN SUPPORT OF H. R. 2341
The emergency character of the national situation fomented l)y illegal claims
of right on the part of public health employees to select by purely arbitrary
means large numbers of human experimental subjects for fluorine research
and treatment raises severe problems of how the public interest may be re-
instituted after the period of neglect and active dissipation which that inter-
est sufl'ered while the great conquest was in its upsurge.
It is now well established by ^^■hat has been said here and elsewhere that
massive fluorine therapy, as comprised in the series of representations and
overt acts called by the daft and wilfully fraudulent title of "fluoridation of
public water supplies," has nothing whatever to do with the practice of medi-
cine or any of its specialists, either of the private practice variety or public-
health blend, nor has it anything to do with any economical administration
of totalitarian medicine, the last having been shown by the series of simple
arithmetical examples given above and published elsewhere, and put in the
hands of the committee, by Manning.
When it was found that the acts, as based upon claims of right, comprising
the astonishing title of fluoridation did not conform to any of the accepted
medical practices then existing or to any of the minimum standards of law,
while it did contain all the elements of assault and battery, it was clear the
term required a formal definition.
A definition was first evolved by Manning out of the facts of massive fluorine
therapy as the practice was introduced l)y employees of USPHS :
"Fluoridation means the experimental mass medication of total populations
by the impregnation of entire water supplies of whole communities with metallic
compounds of fluorine incapable of being assimilated as food, under conditions
of duress, without cessation, or reasonable chance of escape."
When first published in the Springfield Union of March 16, 1951. the word
"experimental" was intentionally omitted from the definition— although it was
clearly required on the facts — to invite the ofiicers of those professions most
deeply involved in sanctioning and promoting the arbitrary selection of vast
numbers of human beings for medical research and treatment with insidiously
poisonous fluorine compounds to reconsider, and then repudiate and denounce
their unwarranted aggression against the patients and family of the petitioner.
216 FLUORIDATION OF WATER
at such time as their moral reawakening might indicate to them the mistalie
they had made (as I then supposed it to be; however, at about that time it
became clear tluit this was no idle mistake on the part of that hard core of
fluorine therapists whose premeditated designs were clearly subject to review
by the wealth of legal talent which we knew the Government bureaus involved
in the massive fluorine impressment possessed).
It is now history that those professional groups, as groups alone, and always
with notable exceptions among the individuals composing them, constantly and
with hard obstinacy in the face of repeated warnings diligently pursued, re-
fused to recognise that any consideration outside the pale of dialectic mate-
rialism held an\ regulatory value upon their conduct. If it was the design of
such a course of group conduct to "lead us to the very death of brotherly love,"
through "all the gruff commands, all the unconditional obedience, all the chilly
ways of bureaucracy," as the parallel induction of unwilling and unwitting
human subjects in concentration camps of Nazi Germany was seen to have
done (see appendix: Doctors of Infamy, v. s., p. 165) the reason for that sad
state may be read in the definition given above.
When the fluorine-for-all madness was first set in motion by its initiators of
the USPHS, the dental profession, for example, held a position in the public
regard, consisting of respect and good will in a degree never approached in
the history of the world, except, perhaps, in the case of certain members of
the clergy and isolated cases of royalty.
Consider the fact that on the mere dictum of dentists who mouthed the state-
ments of their politically chosen oflScers to the effect that this "was a good thing
and ought to be tried," or that it was "a conclusively proven boon to little
children" and therefore must be "inflicted as a benefit," large numbers of group-
ers— heads of organizations relied upon by all propagandists of group control —
reiterated their statements without so much as lifting a finger to verify the worth
of the claims. No other profession can make that claim. But the respect and
good will wliich the elected and appointed leaders of dental and medical groups
held in trust at the onset of the fluorine impressment has undergone a change;
in some places it is entirely dissipated, as to the dental and medical groups,
although, again, the individuals who by their regular and upright conduct have
avoided the blame which attached to their less prudent brethren are still re-
spected as individuals, though the part of their prestige which was appurtenant
to the group is gone for the time being and the hour of its return is unpredictable.
That respect and good will which the dental profession possessed in 1949 was
not the product of the present generation of dentists, nor wholly of their imme-
diate predecessors, but was a fund built up by tempei'ate and prudent conduct
over a period of more than 100 years. It was a fund held in trust, bequeathed
by all honest men in the modest accumulations of their lifetimes of forthright
and considerate dealing. It has been squandered by spendthrifts who did not
even receive one jot of benefit from their spendthrift acts ; like worthless stock
certificates, the swindle sheets of fluorine promotion gave not even the pleasure
of a justifiable spree to those who in reckless extravagance spent what was not
theirs to spend.
All the foregoing applies only to the artifice called by skilled propagandists
of the United States Public Health Service group action and opinion control in
groups, and not at all to the very many members of my profession who without
fear of the cost to themselves have openly or covertly opposed as far as lay
within their power the designs of the young Soviets of public health. The
number of these true gentlemen is so large that a list of their names is impossible
here ; it is far more appropriate to inform the committee that under proper privi-
lege these men can be introduced to the committee's investigators, upon proper
assurances that in so doing the opposers of the fluorine swindle will not be .sub-
jected to the kind of reprisal which is a matter of public record in more than one
city, at the hands of public-health employees or their cohorts who happen to
occupy power positions, for merely having attempted (in some cases unsuccess-
fully) to protect their patients against chemical rape; and if any of these kind
friends choose to endorse this statement or any part of it and exclude the rest,
may they be i)ermitted to do so by the committee.
Last of all, I wish to bring to the attention of the committee, if possible, the
small part which my personal experience has brought to bear upon the problem
of forceful attempts to induct peaceable people into medical experimentation
and treatment for which they have antipathy. It began as a strictly scientific
study wliHii in the years about 191.5 to 1922 and thereafter I investigated the
FLUORIDATION OF WATER 217
electrochemistry of the human mouth. The results were published as listed on
the cover page of this statement and possibly in a few other journals, including
the Pacific Dental Gazette.
Fluorine is the most extremely electronegative of all the elements. This means
that in a circuit of electrical tlow fluorine will be cathodal toward any other
element. That means that fluorine can never be anodal toward any other element.
In brief, fluorine when immersed in an electrolyte, like the human saliva, will
always be in a potential position to receive ions of other elements, but will not
!Sive up ions (permanently at least) to other elements. The cathode in an elec-
trical circuit is always on the receiving end — that is, negative, and the position
toward which ions flow — -while the anode is on the griving-up end, or positive end,
and undergoes los.s of ions, or erosion. This is common knowledge among electro-
platers, such as electrotypers.
The human saliva, being a workable electrolytic solution, supports electrolysis,
electrophoresis, and all manifestations of electrical action. In one side of the
electrolytic process going on in the mouth, slowly but fairly constantly under some
conditions, ions transferi'ed out of the solution of solids called the saliva are often,
though not always, due to modifying conditions, laid down upon looth surfaces by
electrodeposition, in just the same way that stain is deposited out of solution in
a coffeepot, requiring regular scouring to keep it free of the deposits. AVhen this
occurs it is called salivary calculus or tartar.
Tartar is electrically deposited on some teeth, and on some more than on others.
The reverse process is present at times, in which the teeth clearly take on an
anodal character, losing mass and leading to the condition described as a disease
condition called dental caries or tooth decay. The process is measurable. The
process can be set up artificially, not only by a dentist but by anybody who
chooses, of his own free will, to place a pure silver band about the neck of a
tooth and leave it there. When such a silver band is allowed to remain about a
tooth for a period of but a few weeks, an artificially produced lesion of dental
caries occurs beneath and around the silver band, thus one of the basic require-
ments of proof of responsibility of a causative agency for a disease, in this case
the disease of dental caries, is satisfied.
This is not a new observation, the recorded source of it is given in the papers
cited, on Electrobiolytic Theory of Dental Caries, which indicate not only the
actual physical means by which mass is reduced in caries but also show the
reverse process of tartar deposition to be due to the operation of the same physical
forces.
If the process of electrobiolysis observed in dental caries could be reversed, by
chemical or drug or other devices, Manning reasoned, it might be possible to stop
dental caries or avert it. The electrochemistry of the mouth having been verified
to the investigator's satisfaction, a search for a reagent which would combine
readily with tooth structure was begun, and it was no great time until fluorine
was found to be both readily combinable out of one of its compounds with tooth
structure, either the enamel or the inner structures of the tooth, and also to
afford that altered tooth substance a cathodal quality, from which, in both
theory and practice, loss of mass, as in dental caries, was not only impracticable
but did not occur.
But it was also found that sodium fluoride when applied to either the cementum
(root covering) or dentin (inner portion of tooth) rapidly and thoroughly and
permanently deprived the tooth of all sensory nerve response. This presented a
grave hazard, and immediately a promising discovery was rendered so dangerons
as to warrant its suppression. But when events are in the making such matters
are given up reluctantly, if at all, and as a consequence Manning started with
animal experimentation to determine, against a day when the serious nerve-
poisoning properties of sodium fluoride might possibly be subdued or circum-
vented, tho.se two conditions precedent to the commercial exploitation of any drug
which lay upon the hand of the medical innovator the heaviest of obligations.
Those two conditions precedent to commercial exploitation of all drugs are :
1. The determination of a minimum lethal dose of tlie drug, with reference to
units of body weight, to be ascertained over a wide range of experiments on
warm-blooded animals of widest range of body weight, variety, and species,
arranged in series.
Without such knowledge no drug should be introduced into commerce; the
USPHS employees know it. you know it at least instinctively, and I know it and
Jibide by it.
218 FLUORIDATION OF WATER
Such a value is indeterminable for any fluorine compound investigated, due
to the capricous nature, or rather the viperish nature of the element, fluorine,
itself. You do not know the minimum lethal dose of any fluorine compound an
against unit body weights in humans, I do not know it although I have at great
labor tried to find out and that now long ago but still reliable, and the employees
of the United States Public Health Service do not know it although they made
wild statements that "five grams has caused death." No doubt they are right,
but that recklessly misleading statement might result in a large number of deaths
and I am not at all sure that it has not done so.
2. The minimum lethal dose knowledge must be supplemented by knowledge
of a reasonably safe and effective antidote, calculated likewise against body
weight, having a minimum of undesirable side effects and no lasting bad effect
or retention, and capable of ready administration.
Animal experiments show this condition precedent is a vain hope, the lan-
guage of the standard reference book, Merck's Manual, concerning sodium-fluoride
poisoning, when compared with the section on lead, for instance, or when taken
by itself, is testimony as to what happens to sodium fluoride poisoning victims.
Seeing that the way to proper introduction of sodium fluoride into dental
medicine for the purpose of cathodization of human tooth surfaces was barred, I
turned away from the needless and pointless destruction of animals and devoted
myself to maintenance of proper diet so far as lay within my powers of persua-
sion, for the beneflt <^)f my patients. I regret to say that my success in in-
fluencing any important number of people toward use of whole grains, sugars,
and sirups which have been altered chemically to a minimum, and fruits and
vegetables has been negligible, not at all like that of Dr. Fred Miller, of Altoona,
Pa., whose success is a matter of record. Dr. Miller is more able than I am and
more persuasive, and as a master dentist he is to be complimented for his state-
ment to the Select Committee on Chemicals in Food, and there are other Dr.
Millers in this country, but fur my part I have influenced fewer people in correct
food selection and dietary management than any one of a dozen well-known radio
hucksters have in 1.5 minutes. I make this tremendously serious admission
against selfish interest only because somewhere there must be a true record of
our times, and because we are not getting that record in the dental journals
today. In a Nation that almost universally cultivates a silly grin, displaying all
teeth away back to the molars, whenever a camera comes in view, the fabulists
and calamity howlers who create a din over the poorest teeth in the Nation, in
a hundred cities simultaneously, are checked by the pictures tliemselves. We
can get rid of dental caries by ruling out vitiated flours and sugars ; I have
proved it in my own case, and in a few others, and every dentist in this country
worth his salt knows it and believes it thoroughly. The point is so obvious that
I mention it here only to comply with the requirements of the presentation.
There are many other matters of importance which cannot be dealt with in this
statement due to lack of time alone, but there is one which should be brought to
the attention of every legislative body immediately. This is the matter of
remedy. It is presumed that where one finds fault with the existing state of
things, the faultfinder should propose a reasonable and legal and workable
remedy.
There is not the slightest question that public health officials have gone too
far in this matter of forced fluorine therapy. How much too far they have gone
is a matter for our courts to decide. They have gone too far in other lines also,
but it is not only the exces.ses which have been practiced but the entire setup of
means and methods which requires now a thoroughgoing investigation.
It has been the experience of men — and children — that they are happiest when
working under minimum restraints, such as the restraints of' law which are cer-
tainly minimum, for these legal restrictions are the lowest form of restrictions,
the mere infringement of which results in penalties, whereas the infringement
of the higher restrictions, such as the nobler moral restrictions placed by every
man of character upon his acts, both the unseen and the seen — and nobody is in
a better position to observe this pcnnt than a practicing dentist — is not accom-
panied by any penalty at law.
Reasonable minimum standards placed upon the principal representatives of
branches of science also tend to build and preserve that branch of science where
they are observed, by curbing excesses of modes and manners.
Gross failures to observe comm(m medical manners by doctors in Massachu-
setts, the invention of deceitful subterfuges such as the insincere political fare-
thee-well called home rule publicly and — among the political initiate— a gim-
FLUORIDATION OF WATER 219
iiiick which I believe is sutter languasie for brass knuckles, led to the filing of
a medical bill of rights for the 1954 session of the Massachusetts General Court.
Just as we have uniform sales acts, uniform negotiable instruments acts, and a
uniform bankruptcy act, so the commerce and travel of this Nation must in some
way be safeguarded by a uniform medical 1)111 of rights or some such device to
shield the unwary traveler who must visit given areas on business from excessive
medical enthusiasms of the adventurers who, having gleaned a few facts from
their extension courses in the Pocket Digest School of Medicine, become obsessed
with the delusion that every human b^^i ng in sight can be lassoed for a set of
unspeakable experiments with this or that nostrum of the moment.
The couunittee may find also tliat the appended text of the Massachusetts House
bill No. GOT, recently reported out unfavorai)ly, but favored by the chairman of
the Joint Committee on I'ublic Health of the General Court, liolds constructive
interest in that it was drafted by a practicing dentist, along with H. 608, a bill ^
patterned on the expertly drafted H. R. 2341 of the United States Congress, and *
the minority report of the Massachusetts Study Commission ou Fluoridation
of Public Water Supplies.
TEXT OF PROPOSED MEDICAL BILL OF RIGHTS, OR UNIFORM MEDICAL RESEARCH BILL
(Note. — This bill is patterned on a dictum in the decision of United States
tribunal No. 1, dated August 19, 1947, at Nuremberg, the court composed of four
United States judges acting under authority of control council law No. 10.
Certain medical insolences have been removed from the area of conduct defined
by the bill, such as the preposterous expression "before the acceptance of an
affirmative decision by the experimental (human) subject * * *" but with the
exception of placing moral qualifications upon medical experimenters the bill
follows the so-called Ten Standards in the main.)
A Uniform Medical Bill of Rights, Proposed To Protect Travelers and Engaged in Commerce
from Impressment Into Medical Research and Treatment Initiated, Conducted, or En-
gaged in by Local Enthusiasts of Totalitarian Medicine
Section 1. The voluntary consent of the human subject to undergo medical
or surgical experimentation is absolutely essential. Such consent must be ex-
press, it cannot be implied, and must be based upon complete Information to the
proposed human subject by the experimenter, who shall explain beforehand to
tlie proposed subject the right to withdraw from the experiment at any time.
The proposed human subject shall have the legal capacity to give consent; shall
be so situated as to be aitle to exercise free power of choice, without the inter-
vention of any element of force, fraud, deceit, duress, overreaching, secrecy
concerning any and all details known to the experimenting doctor or researchist,
or other ulterior form of constraint or coercion ; and shall have before the intia-
tion of the exijeriment such sufficient knowledge and comprehension of the
subject matter involved as shall enable him to make an understanding and
enlightened decision whether to become a subject for the experiment.
This latter element requires that before the experimental human subject
affirmatively engages in the experiment by his own decision there shall be made
known to him the nature, duration, and purpose of the experiment, the method
and means by which it is to be conducted, all inconveniences and hazards reason-
ably to be expected, and the effects upon his health or person which may possibly
come from his participation in the experiment.
The duty and responsibility for ascertaining the quality of the consent rests
upon each individual who initiates, directs, or engages in the experiment. It is
a personal duty and responsibility which may not be delegated to another except
under the highest degree of care.
Sec. 2. The experiment must promise a recognizable likelihood that it will
result in good for humanity, unprocurable by other means or methods of study,
and must not be random or unnecessary in nature.
Sec. 3. The experiment shall be so designed and based upon the knowable facts
of medical art and science as to support a reasonable anticipation of resultant
benefit to human beings.
Sec. 4. The experiment shall be so conducted as to avoid all unnecessary
physical and mental suffering and injury.
Sec. 5. No experiment may be initiated or conducted at any stage of which
there is reason to believe that death or disabling injury will possibly or prob-
ably occur, except (by enabling act of Congress).
48391—54 15
220 FLUORIDATION OF WATER
Sec. 6. The degree of risk to the human experimental subject shaU never
exceed that determined by the humanitarian importance of the problem being
studied.
Sec. 7. Proper preparations must be made and adequate facilities provided
upon the highest standard of care to protect the human experimental subject
against all foreseeable possibilities of injury, disability, or death.
Sec. 8. The experiment shall be conducted only by morally and scientifically
qualified persons. The highest degree of care shall be maintained throughout
the planning, progress, and postexperimental stages of the experiment, by those
who initiate, conduct, or engage in the experiment.
Sec. 9. The human experimental medical subject shall be at liberty at all
times during the course of the experiment to bring it to an end by signifying
that he has reached the mental and physical state where continuation would
«eem to him to be impossible or to exceed his free choice and voluntary consent.
Expression of the wish to withdraw from the experiment shall require im-
mediate cessation of experimental use of the subject. The experimenting
doctor or researchist shall remain alert at all times to see and put into effect
any implied wish of the experimental subject whenever his afiirmative and
voluntary consent becomes in the slightest degree uncertain, and must under
all conditions act as the advocate of the human subject.
When the human subject withdraws from an experiment before its completion
he shall be free from all contractual obligations to the contrary, and any contract
to compel continuance or to indemnify the experimenting doctors or researchists
for withdrawal shall be null and void.
Sec. 10. The initiators, conductors, and those who engage in the experiment
shall be prepared to terminate the experiment at any stage, if they or any of
them have probable cause to believe in the exercise of the good faith, superior
skill, careful judgment, and moral responsibility required of them that a con-
tinuation of the experiment may possibly result in mental or physical injury
to or disability or death of the human subject.
Claimants of right to carry out massive experimental fluorine therapy upon
arbitrarily selected human subjects among American free men, having objected
to the interposition of the principles of the 10 standards of the Nuernberg
decision, by those free people, as a scurrilous sophistry, while at the same time
claiming those standards as a principal defense of inmates confined in concen-
tration camps in Nazi Germany (often as a posthumous defense, or rather a
retaliation) and having found no resistance to publication of their comments
in JADA, the Journal of the American Dental Association, will be compelled
to compare the treatment dealt out to the subjects of fiuorine experimentation
with that written consent to perform an autopsy, or to carry out medical experi-
ments on prisoners confined in jail, which experience has shown to be necessary.
If the protection granted by judges of the United States Government to
political prisoners confined in' Germany's concentration camps is greater than
the protection which we as American free men can obtain against unexplained
and unconsented experiments, such as those carried out with wildest abandon,
in the random^ and unnecessary and wholly uncontrolled fluorine experimental
research and treatment, from our law, enforcement agencies, then we are
forced to appeal to our next line of defense against oligarchic controls, the
legislative branch of our Government.
Here we hope to obtain the necessary relief in fact we feel so certain that
our legislators will find this their personal problem that we will forego any
forecast of the course of further search for remedy, secure in the belief that
the protection sought will be forthcoming promptly.
The Chairman, It will not be possible to include in the record all
of these newspaper articles you have submitted to us, however.
I would suggest if you wish these you are free to take them or you
may leave them as exhibits with the committee as you desire.
Dr. Manning. Thank you, sir. We hope to be back. You will see
us again, I am quite sure.
(The newspaper articles referred to have been placed in the com-
mittee files.)
FLUORIDATION OF WATER 221
STATEMENT OF MES. HARMON SWIFT, ASSOCIATE EDITOR OF THE
SOCIAL SPECTATOR, NEW YORK CITY
Mrs. Swift. The ex-mayor of Grand Rapids, who was in office at
the time that fiuorination was put in Grand Rapids, told me it was
in about 1933 or 1934 that Grand Rapids was fluorinated.
When I spoke to him I said "But we do not have a record of that.
It is supposed to be 1945."
He said, "Oh, no. It was put in in the thirties in Grand Rapids."
My interest was because my brother and his family live there and
they have very bad health at the moment.
The Chairman. Off the record.
(Discussion held off the record.)
The Chairman. We will conclude with the proponents of this
legislation. I see a gentleman in the rear who has arisen and de-
sires to say something. I assume not withstanding all we have heard
there is something new.
STATEMENT OF DR. C. T. BETTS, TOLEDO, OHIO— Resumed
Dr. BETTS^-Jt-getreports from all over the country, and I find men
like my ^nator TaJb, died after drinkino^ this water 1 year.
I find iStrpreme Court Justice from Kentucky also buried after
drinking the water 1 year.
Many of our Senators and Representatives have gone since this
town has been fluorinated.
The Chairman. Dr. Betts, if you wish you can extend the re-
marks you made yesterday to include what you have just said if you
prefer to elaborate on them.
Do we have someone else ?
' Mrs. Lilllvn Vandermere. I wanted to say that I would like to ex-
press my gratitude to you and your committee for having given us
your excellent attention, to us the proponents of H. R. 2341.
The Chairman. At this point in the record will be inserted the
statements of the proponents of H. R. 2341. I have the following
material :
Letter from Dr. Arthur B. MacWliinnie, Seattle, Wash.
Statement of Mrs. Josephine McQueen, Loudon, Tenn.
Statement of Mr. H. L. Prestholdt, Minneapolis, Minn.
Letter from Mr. Charles C. Deubel, Jr., South Orange, N. J.
Statement of Dr. George L. Waldbott, Detroit, Mich.
Letter from Mr. Pierrepont E. Twitchell, president, Citizens
Medical Reference Bureau, Inc.
Letter from Anna M. Ferguson, Washington, D. C.
Statement of Dr. George J. Brett, Lancaster, Pa.
Statement of Mr. Anthony J. Romeo, 12 Romeo Avenue, Mas-
sena, N. Y.
Letter from Dr. A. R. Gould, San Francisco, Calif.
Letter from Mrs. Robert H. Crane, Anchorage, Alaska.
(The statements referred to are as follows:)
222 FLUORIDATION OF WATER
Seattle, Wash., May 22, 1954.
Elton J. Latton,
Clerk, Interstate and Foreign Commerce Committee,
House Office Building, Washington, D. C.
Dear Sir : For financial reasons I cannot act on the notice sent me regarding
committee hearings on H. E. 2341 to appear before the committee.
Were I to appear, my statement would be an elaboration and citing of many-
instances of restriction of open discussion of the question of fluoridation by
members of the dental profession in a position to gag opposition, not only in
Seattle, but elsewhere. It would point out that such tactics appear general in
the profession, and the endorsements of the A. D. A., therefore, become mean-
ingless.
That the great preponderance of dentists endorse fluoridation under these
circumstances gives stature to those who, after thorough investigation of both
sides of the question, now oppose oflScial position.
The enclosed statement which appeared in Oral Hygiene is a condensed version
of what my statement today would be.
I request that it be read into the record of these hearings.
Sincerely,
Arthur B. MacWhinnie, D. M. D.
On this day of May 22, 1954, Arthur B. MacWhinnie personally appeared
before me and executed the foregoing instrument, signing same as his free and
voluntary act and deed.
[seal] Blanche Opperman,
Notary Public (for State of Washington) .
[Reprinted from the January 1953 issue of Oral Hygiene]
NaF Fluoridation Is Compulsory Medication
(By Arthur B. MacWhinnie, D. M. D.)
Step by step, a piece at a time, our Government planners with their vast
resources of money, manpower, and time, are weaving a pattern to destroy all
vestiges of self-sufliciency in the average American and deliver him as a slave
to his Government ; often this is done under the guise of "social progress."
We have all been aware of this for years, and have deplored the planned
destruction of the very qualities that have made America great. With the
exception of voting at the polls, there was nothing the average dentist could do
about it, vmtil the advent of fluoridation.
It may be coincidence, but about the time the American Medical Association
(aided by the dental profession) took a magnificent stand against Oscar Ewing
and his Federal Security Agency and their plan to set up compulsory health
insurance, the United States Public Health Service (also led by Ewing) suddenly
concluded that fluoridation experimentation had gone far enough and was ready
to be forced on the public, largely without their knowledge or consent.
If they could not initiate the whole program, they would attempt partial
compulsory mass medication, in principle and fact, by spreading their entire
weight and resources over the Nation at one time.
administering fluorides by prescription allows individual freedom of choice
IN accordance with each patient's requirements
I, too, was swept off my feet at the first onslaught of fluoridation in my com-
munity.' I spoke for its adoption at several large meetings. It was not long,
however, before questions arose in my mind as they have in the minds of all
thinking dentists.
I reversed my position when I suddenly realized how eftsy it is for man to
become totalitarian in his thinking; when he thinks he knows what Is right and
^ood for everyone; and attempts to force his decisions on others without their
consent. Try that in your dental practice and see what happens. Your patients
make the final decision as to which of your services or suggestions they will
accept, and they can reject all or part. That is the way democracy should
operate.
I could not deny the possible benefit of fiuoridation to children, despite its
totalitarian aspect, without having an alternative to offer. If I could find an
alternative, there was no reason whatever for my dictatorial thinking. On
FLUORIDATION OF WATER 223
discussing tbe problem with my pharmacist, I fouud to my delight that there was
another way of administering fluorides, less costly and in a purer form than the
Government's method, and one which would he voluntary.
I rushed to report my tindings to the dental profession. I received a great
shock, for. in what I had still considered a free America, the platform of the
Seattle District Dental Society was denied me to sjjeak against fluoridation,
although the request was made two meetings in advance. We heard speakers
for fluoridation at every regular meeting from December 1951 through March
1952.
I then decided to write my report for my State Journal. I have been a member
of the publications committee for several years, writing editorials which the
profession apparently liked. Again I was stunned. My editorial, presenting
"iU-gumeuts on both sides of the question, was removed at press time by the
conuuittee for fluoridation. If the profession is not qualified to discuss this
question, then who is?
I lound, however, that a few wide-awake dentists had been prescribing fluo-
rides for years and were violently opposed for many reasons to the principles
of mass prescribing and compulsory mass medication. You, too, can prescribe
then* if you and your patients believe, as I do, fluorides will reduce dental caries.
In my office, no charge is made for a prescription to my regular patients. It is
part of our service.
Sodium fluoride "milk drops" are available. Four drops provide the daily
dosage. The drops can be added to fruit juice, water, milk, or the baby's formula ;
or they may be put on his cereal. The cost of this chemically pure drug is about
1 cent a day.
Quick dissolving tablets containing 1 milligram of .sodium fluoride (C. P.) also
are available. Add one to a glass of any liquid the child drinks and he has
received his daily dose. A tablet may be added to each quart of milk or fruit
juice, and the quart bottle of water you keep in the ice box ; then whatever the
child may drink during the day, he is receiving the governmental concentration —
but who knows what total dosage?
For economy, large capsules are available. Each capsule is designed to treat
one 26-ounce box of salt, iodized or plain. A dozen of these capsules cost $1,
and it is probable that a dozen boxes of salt will last a family 3 years or more,
fiud the entire family receives an adequate dosage.
Vitamin C and D tablets are available which contain fluoride in the proper
dosage. These are somewhat more expensive.
All of these methods have been used successfully for some time, but they have
not received proper publicity. With a fraction of the space that is devoted in
our journals to plumping for Government medication, these methods of fluoride
medication could be publicized in a short time. Why hasn't this been done?
Now that this information has been published, which has long been denied
you by our official journals, there is no longer any reason for dentists to support
the case for Government medicine.
With several choices to suit the needs of different families, it is difficult to see
why anyone should feel the necessity of impregnating the entire water supply of
a city except for two reasons :
1. Compulsion, which is a dangerous step.
2. xVdditioual power and control for Government bureaus.
Of course, I realize that some patients will not follow this treatment even if
it is prescribed — the public health dentists have found this to be the case. Is
that a valid reason for resorting to conipulsitm?
Frtciloiii of choice
No voluntary method is as efficient as compulsion. But I still prefer the prin-
ciple of freedom of choice, especially when my refusal to consume a drug neither
harms anyone nor prevents others from having it.
The Public Health Service claims to be concerned with the health of all the
people of this country. What steps are they taking to provide fluorides for over
one-third of our entire population who do not drink city water? If they succeed
in the fluoridation of sufficient public water systems, they actually will prevent
the use of any other method that will benefit all the people.
The salt companies' soon will be in a position to use European patents for
treating salt with fluorides — if there is enough of a market left to make it worth
1 When this product is marketed, there will be no need for fluoridation of water supplies,
nor prescribing. All Americans, rural as well as urban, can Lave fluorides in proper dosage
without increasing Government payrolls 1 cent.
224 FLUORIDATION OF WATER
their while. Then, tinder the guidance of the dentist or physician, the patient
may choose or reject the fluoridized salt sold at his grocer's.
You may recall the attempt a few years ago to add iodine to the water supplies.
Other ways were found to provide children with this drug and before long it was
learned that iodine aggravated certain types of goiter.
The question is : Shall we turn over our children's dental care to the Govern-
ment or will the profession continue to control it? Given this power, the Gov-
ernment bureaus will continue to reach for more.
I will yield my right to prescribe and control fluoride medication for my
patients to private enterprise, rather than to a Government bureau. This is one
Government control that we, as dentists, can aid in eliminating.
I prefer the middle of the road. Let us prescribe fluorides for children with
their parents' consent, only when they may be beneficial.
After extensive testimony from a host of leading scientists, the Delaney con-
gressional committee investigating fluorides says, "Go slow." Long-term effects
of fluorides only now are being investigated.
Dentists, physicians, lawyers, and businessmen led the fight that defeated
fluoridation in Seattle. They are prepared to help others.
Do you have the will to resist?
1025 Medical-Dental Building, Seattle 1. Wash.
Statement of Mrs. Josephine (Tom) McQueen, Loudon, Tenn.
Mr. Chairman, for many years I have been deeply concerned over the wide-
spread and growing use of fluorides in water systems.
While I myself, do not have a professional background in this line, I have
talked with many of the leading authorities concerning the harmful effects of
fluoridation. I am distressed that more emphasis has not been placed iTpon
the evidence of those who oppose fluoridation and I respectfully ask that they
consider the data which I have gathered.
I present first a leaflet with statement by Dr. Clive M. McCay of Cornell
University.
fluorides poison to all living tissue
We have long studied fluoride in the body and do realize that it accumulates
in bone. We believe, as a whole, that the putting of fluoride in water is being
pushed too rapidly. The original plan was to study the matter for 10 years and
only a little more than half this period has passed.
As a whole, the medical profession knows very little about the matter, so they
are approving it.
The dental profession in most areas can say nothing because they will be
accused of selfish motives if they show any signs of opposition.
Therefore, most of them agree.
However, there is a group of dentists in New York City who do believe that
the data are not sound.
Clive M. McCay, Ph. D.,
Agricultural Experiment Station, Cornell University, Ithaca, N. Y.
At your drugstore look in the big book "Analogous changes in teeth,
entitled : "Bones become hard and fragile.
"The Dispensatory of the United "The use of fluoride-containing den-
States of America — ^24th edition" page tifrices and internal medicants is not
1456. justified."
"Fluorides are violent poison to all United States Department of Agricul-
living tissue because of their precipita- ture. Yearbook 19.39 —
tion of calcium. They cause fall of "Food and Life" pages 212 and 213.
blood pressure, respiratory failure and "It is especially important that fluor-
general paralysis. Continuous inges- ine be avoided from birth to the age of
tion of nonfatal doses according to Soil- 12 years."
man (J. Pharmacol.; 1921, 17, 197)
cause general cachexia and permanent
Inhibition of growth.
I had been told by the proponents of fluoridation that the statements made
by Dr. McCay were obsolete and would not now fit the present situation. In
reply to these arguments I would like to offer a letter from Dr. McCay dated
April 28, 1954, in which he refutes any statement that his leaflet is now
obsolete.
FLUORIDATION OF WATER 225
New York State College of Agriculture,
Cornell University Agricultural Experiment Station,
Department of Animal Husbandry,
Ithaca, N. Y., April 28, 1954.
Mrs. Josephine INIcQueen,
McQueen Farms, London, Tenn.
Dear IMrs. McQueen : Thanks for your letter of recent date.
I cannot see how your information concernin,^ fluoridation of water can be
out of date. I believe the following facts still stand. In the first place, I know
of no physician in any health department who has ever done any work with
fluorides. In the next place, I know that among dentists there is substantial
division in the regard to the use of fluorine in water, although dentists will
not express themselves in public because they fear bad public relations if they
vote against fluoridation. Finally, I know of no foreign country that is making
use of fluorides in water, although I am certain that teeth in countries such
as England, Switzerland, and Sweden are bad or worse than those in America.
I also know that while I was living in Switzerland, there was a scientiflc com-
mission considering the problem and this commission had been in existence for
some time. If this panacea is a hundred percent satisfactory, why have these
scientific commissions that are under far less political pressure than they are
in the United States refused thus far to put fluorides into any of the water
of these foreign nations? I understand that when the representatives from
England came to visit this country, they were piloted around in much the Russian
fashion showing them only the people in favor of fluoriding water.
I cannot see how any of these facts have grown out of date if you have them.
I, myself, believe that all of us wish to do the best possible for the children,
but that we do not wish to dive into this matter in a huge nation when smaller
nations with scientists who are equally as good are refusing to go in.
Yours sincerely,
Clive M. McCay,
Professor of Nutrition.
Then, I also respectfully ask that the committee give considei'ation to the
statement made b.v Thomas H. Allen, president of the Memphis Light, Gas, &
Water Division of the city of Memphis.
Mr. Allen has had much technical assistance and advice in the preparation
of this statement, and this, coupled with his many years of experience in the
water division, makes him extremely well qualified. This is a revised copy
and was submitted to me by Mr. Allen with his letter of April 19, 1954.
Memphis Light, Gas & Water Division, City of Memphis,
Monphis, Tenn., April 19, 195^.
Mrs. Tom McQueen,
Loudon, Tenn.
Dear Mrs. IMcQueen : Enclosed is a revised copy of Fluoridation of the Mem-
phis Water Supply. My reasons for making revisions are as follows :
Page 2, the paragraph relative to iodine tells the story correctly, but it was
put into practice in such a small area that it could be misunderstood. In fact,
it has been misunderstood. It was found that salt containing iodine could be
used without running the risk of giving iodine to people who did not need it,
and the result was that this whole program was dropped by the public health
service.
The statement in my original paper is correct, but the whole program did
not get very far before the change in policy was announced.
Referring to ninth paragraph on page 6, we found that it would be better to
make a broader statement relative to the differences in the different types of
fluorides, and a new paragraph has been substituted for the original one.
As revised, this paper may be used.
I will appreciate your returning the first copy to me.
Very truly yours,
Thos. H. Allen, President.
226 FLUORIDATION OF WATER
Ft-Uoridation of the Memphis Water Supply
the public good
The Board of Light, Gas & Water Commission is ready to do everything that
contributes to the public welfare. When convinced that fluoridation of the
Memphis water supply will contribute to the welfare of all the people, I can
promise that no time will be lost in putting in the equipment necessary to do
the job regardless of the energy required or of the cost.
However, it is an obligation of the board to supply a safe, sanitary water for
public consumption. Pure water is an essential. It is the most important of
the three services rendered by the division.
Until the evidence is completely convincing, I am sure that this board will
not add fluoride to the water supply.
I have been accused of being bullheaded about this. I am and will continue
to be until I am sure that any change made in the water supply is. in fact, for
the benefit of all the people. This is my duty. Surely nobody would want
those in charge of the water supply to be otherwise. I, therefore, plead that we
approach this problem with recognition that we should be hard to satisfy and
that no amount of pressure should make us yield in this matter : and likewise if
convinced that fluoridation is for the liest and that no amount of pressure should
deter us from adding fluoride to the water.
First : Controlled studies, under scientific supervision, are under way in only
;i few cities. These experiments have not been underway for a sufficient length
of time to establish any conclusive facts as to either the benefits or ill effects of
fluoridation on the complicated human system.
Years ago when I was a young man, the dentists solved many problems —
temporarily — by killing the nerves of the tooth. It took time to develop the
disastrous effect of that mistake. Of more recent date, I recall so many teeth
that were condemned because they were dead. These are all recollections and
nothing more. I am sure you get the point.
Second: How much fluoride? The LTniversity of New Mexico, where large
areas are blessed or cursed with too much or too little fluorine, has made studies
relative to fluorine poisoning and mottling of the teeth in various degrees. The
destructive effect of too much fluorine upon human teecth can be horrible
to the person so affected.
It has been brought to the attention of the public that a water supply having
0.5 part per million of fluorine produced mild fluorosis in D percent of the
children 12 to 14 years old, and that a supply of 0.7 part per million produced
fluorosis in the same age bracket of 12.6 percent.
It is proposed to add 1 part per million to IV2 parts per nrillion to the Memphis
water.
These recommendations and discussions do not take into account the dif-
ferent chemical characteristics of the different water supplies. Perhaps it
makes no difference. But Ohio River water at Cincinnati and Louisville, water
from the Great Lakes, Mississippi River water, and Memphis well water are not
the same. Climate and geography may have a bearing. These questions have
been raised ; they have not been answered.
The amount of dosage of any medicine for one child would not necessarily
be correct for another child. Surely the correct dose for a 2-year-old would not
necessarily be correct for a 12-year-old.
And no matter what the dose, what effect will 1 percent of fluoride have on old
I)eople, on sick people, on bones, on lungs, or .ioints?
Third: By what authority does an individual or group have to administer
medicine to another person for treatment of an uncommunicable disease? Do
any of you contend that we have a right to prescribe medicine for you and your
children whether or not you want to take the medicine? "Very few individuals
stop me on the street or elsewhere to urge fluoridation. Many stop me to protest
the use of fluoride. Do we have a right to administer a medicine to those'
people in the absence of the threat of an epidemic — medicine they do not want
to take?
Admittedly, fluorine is a rank poison, and, admittedly, just the proper amount
should be added. This amount is usually referred to as 1 part per million. It
has been suggested by a State public health official that should Memphis add
fluorine this dosage should be reduced to 0.8 part per million. What this means
is, that if you put 1 ounce of fluorine in 7,500 gallons of water it will be too
much. This should be reduced to 0.8 of an ounce to be proper. In other words.
FLUORIDATION OF WATER 227
there is a difference of 20 percent between what is good and what is bad. Is it
not common liuowledge that the water intake by individuals and the ability
of individuals to assimilate elements varies much moi'e than this 20 percent, and,
therefore, is it not (;lear that there is no way to add any of the presently avail-
able fluorine compounds to a public water supply except that the amount added
may be proper for some, but will definitely be improper for many? This should
indicate that a dosage of fluorine as now constituted suited to a particular
bracket and administered to all elements of society certainly appears to be an
inaccurate, unscientific, and unprofessional approach to a health problem.
It is so important to linnt the amount, yet it never seems to occur to Ihe
dentists that one person will drink more water than another, and more in hot
weather than in cold. So many questions go unanswered that I become fearful
that the whole program is carelessly conceived.
Fourth : Should we use fluorides on our lawns, in steam plants, electric bat-
teries, bakeries, and all the other commercial and industrial plants whether
they like it or not? Perhaps it will do them no harm. Should this not be
predetermined by exhaustive tests?
Fifth: The Public Health Service states: "National organizations of pro-
fessional health workers, impressed by the findings of decades of research on
fluoride and dental decay, have endorsed the adding of fluoride to community
water supplies. They include: American Dental Association, State and Terri-
torial Dental Health Directors, American Association of Public Health Dentists,
Public Health Service — Federal Security Agency, State and Territorial Health
Ofiicers, American Public Health Association, and American Water Works
Association."
This statement is not so. The correct statement can be found in the Journal
of the American Water Works Association, volume 41, page 575, which reads
as follows:
"The Fluoridation of Public Water Supplies
"statement of recommended policy and procedure
"In communities where a strong public demand has developed and the pro-
cedure has the full approval of the local medical and dental societies, the local
and State health authorities, and others respcmsible for the communal health,
water departments, or companies may properly participate in a program of
fluoridation of public water supplies."
Thi.s is not an endorsement.
Waterworks men are mostly engineers and chemists dealing with the ordi-
nary problems of water supjdy and water treatment. They are not equipped
by training to deal with a medical problem such as fluoridation.
This statement clearly states that if those responsible for the health of the
community will take the responsibility for fluoridation, that the water depart-
ments may participate by actually adding the fluoridation, that the water de-
partments may participate by actually adding the fluoride to the water. And, In
the recommended procedure, the water utility should he relieved of all liability.
Sixth : But I see no way for the water department to escape liability. Ap-
paratus may go wrong, men may make mistakes, and overdosage may result.
If your children or grandchildren (I am concerned about the grandchildren)
turn up with mottled teeth, who pays the damages? Will the Council of Civic
Clubs write the guaranty to hold the division harmless and back it with liability
insurance of suflicient amount to cover the possible claims from 400,000 people?
Seventh : The dental society has instigated numerous statements on fluorine
but has failed to tell the public what a local dentist told a group in Memphis,
which was that, in general, dentists do not like to serve children and that by
putting in the same time on adults, they can gather in more money. Since
certainly most dentists have received their education and training largely at
public expense, they should feel obligated to serve all elements of the puhlic,
including children.
Eighth : Statements have been made to the public that by adding fluorine,
an improvement of 65 percent results. This is a figure obtained by project-
ing a curve into years ahead and is not the record of what has actually been
accomplished. Since this is the case, one would be interested in how the
figure of 45-percent improvement resulting from topical applications was arrived
at. Since all the emphasis on fluorine has been in one direction only, it could
be that the 65-percent figure is too high, and the 45-percent figure is too low.
228 FLUORIDATION OF WATER
However, assuming the figure of 45-percent improvement, resulting from topical
applications, to be correct as claimed by the dentists, is it not commonsense
to send the child to the dentist every 2 years and have fluorine applied? This
visit should be made regardless of fluorine, and while there the simple appli-
cation can be made, thus bestowing its benefits to the one who needs it, without
involving the many thousands who cannot profit by its use and do not choose
to be forced to swallow it. In any event, this procedure for better or for worse
limits the hazard to those who wish to take the chance.
Ninth : As I understand it, fluorine is present in many foods and is essential
to the human body. Sodium fluoride, the substance proposed to be used in our
water, is a deadly poison, and is entirely different from the various complex
fluorine-bearing compounds, organic and inorganic, occurring in nature.
Tenth : When I first heard of the proposal to fluoridate public water supplies
as a cure for decay of teeth, my immediate reaction was "wonderful." It seemed
so easy to do.
When I learned that too much fluorine might discolor, mottle, or destroy the
teeth, requiring accurate control of the amounts introduced into the water supply,
I decided that the program could be a first-grade nuisance to the water division.
Every time a mother found a cavity in a youngster's tooth we would be at
fault for not providing enough fluoride ; and whenever some youngster developed
discolored or mottled teeth, the wrath of an outraged family would be unspar-
ingly poured upon our heads. As a nuisance possibility it made me shudder, and
I began to be afraid of it, because if it could be a nuisance, it could be dangerous.
Sabotage is an ugly word. The enemies of America have not overlooked the
possibility of using the water supplies of the country to sabotage the health of
the people. It is an item that has given us some concern in preparing the civil-
defense measures necessary in case of war.
If we fluoridate our water, we will equip all of our plants to inject a deadly
poison into our water. Has it occurred to any of you here that saboteurs, just
one in each plant, by turning a valve, could inject a tasteless poison into our
water in deadly quantities?
CONCLUSION
Speaking for myself only as an officer of the water division, I am not convinced
that fluoridation is desirable, or even safe.
It should be understood that I have not reached any final conclusion about
the matter other than a definite decision that we should not risk spoiling the
best water supply in the Nation unless there is definite and conclusive proof that
the addition of fluorine to Memphis water will be of benefit to all the people,
worth what it wi'l cost, and that the use of fluoride is safe for all the people —
young children, old people, well and sick people. Since the responsibility falls
on the city government and the division, I feel, in the absence of convincing
proof, that the answer should be "No."
In conclusion, Mr. Chairman, I feel sure that the committee will give equal
weight to both sides of this important issue since undoubtedly it will directly
affect all of us and all of our families.
I feel that in view of the serious consequences of fluoridation the committee
should exhaust every possible means of investigating this proposal before taking
favorable action.
Statement of Views on Proposal To Make It Unlawful To Add Any Fluoride
Compound to Public Drinking Watek, by H. L. Prestholdt
This statement refers to H. R. 2341, introduced by the Honorable Roy Wier,
intended to make it unlawful to dissolve any fluoride compound in waters
intended for human consumption.
For the purpose of this statement, whenever fluorine, fluoride, sodium fluoride,
or the fluosilicate, or when any of these terms are used it means, and the reference
is to a fluoride compound irrespective of its nature, composition, or physical
property.
The element fluorine is a member of the halogen group. It is extremely
poisonous, dangerous to handle, and found in nature usually in combination with
calcium.
Several years ago, it was brought to the attention of several scientists that
wherever the soil or water contained quantities of fluorine, that invariably in
FLUORIDATION OF WATER 229
such areas, a number of people suffered from fluorosis. Considerable work was
undertaken at that time to discover some practical means by which the fluorine
or fluoride could be removed.
Sodium fluoride is the salt of an alkali and hydrofluoric acid. This acid is
the result of a combination between the fluorine gas and the element hydrogen.
When the element sodium is added it will combine with the acid to form sodium
fluoride and by adding silicon, it will then form the sodium fluosilicate. Both
of these salts are extremely poisonous and are frequently compared with arsenic,
but they are considered more dangerous because of the great affinity of fluorine
for calcium. .
Salts or compounds containing fluorine are not recognized as having any
therapeutic or medicinal value. A thorough search of medical literature does
not establish or reveal any pathological condition where a fluoride compound is
recommended either for internal or external use.
Physiologically, the sodium fluoride or the fluosilicate appear on the market m
a white, heavy, dusf-fine power. It is being offered in two distinct grades, the
commercial and the chemically pure. The commercial grade contains from 90
to 95 percent of sodium fluoride, the balance being inert or impure ingredients
difficult to dispose of or remove. It is tasteless and odorless and completely
soluble in water ; and, because of these characteristics, it has been used exten-
sively as a rat poison or pest exterminator.
The principal source of the fluorides are the piles of slag containing the ele-
ment fluorine and is the result of the use of ciyolite in the extraction of the
metal aluminum.
Sodium fluoride or the fluosilicate does not appear in nature as such. They
are manufactured and usually from the leftovers at the aluminum plant. The
piles of these byproducts are difficult to dispose of as it is largely waste and
because of the danger associated with any materials containing fluorine, it has
been a manufacturing problem for many years.
There has been a great struggle going on for considerable time to dispose of
this waste. It is not permitted to be dissolved in rivers or streams. It is
against the law to dispose of this material in the river or sea. The reason why
is due to the inherent risks with possible effects on wildlife and farm stock.
Great effort has been made to find an outlet for the fluorides. It is used quite
extensively in art and industry especially in manufacturing adhesives and paints,
but there is not sufficient industrial use to consume the constantly increasing
quantity of waste containing fluorine, largely due to the enormous expansion
and development of the metal aluminum industry.
For almost a generation, it has been recognized that in the fluoride sections
of our country — notably the States of New Mexico, Arizona, Colorado, and cer-
tain counties in the State of Texas — there is a percentage of fluorine in the
water and the soil. It is in these localities where endemic fluorosis is prevalent
both in humans and the animal kingdom. This discovery has led to many
different opinions, but scientists have definitely brought out the fact that when
young children in the age group from 8 to 10 years ingest fluorine or its com-
pound that the incidence of dental caries are somewhat reduced as compared
with similar conditions existing in localities or other States where the fluorine
content of soil and water is practically nil.
It is not generally understood how nature dissolves the fluorides because
calcium fluoride is insoluble. Somehow, nature has converted the calcium
fluoride into a soluble substance where it is even possible for plantlife to absorb
it and vegetables grown in soil tinctured with fluorides are found to be rich in
fluorine.
Despite this situation, there is great opposition to the natural fluoride com-
pound in these States because it leaves the teeth in a mottled, jagged, and brittle
condition. It is an established fact that dental fluorosis is found in these com-
muiiitios with drinking water that contains 1 part per million and when the
permanent teeth of children so raised they tend to erupt more or less chalky
while in color and later tend to become pitted and stained yellow, brown, or
almost black.
Scientists upon careful investigation admit that the teeth are less prone to
decay at an early age, but subsequent to childhood these facts are reversed. The
fluoride content is then proven to be a masking operation. The teeth become
infinitely more susceptible to decay and are so brittle it is difficult for any dentist
to accomplish needed repair.
Cognizance has been taken of these facts in the communities where the fluorides
are naturally in the soil and water. It is frequently referred to as "natural
230 FLUORIDATION OF WATER
fluoride," which is fully justified because calcium fluoride is in itself insoluble ;
and, secondly, because the method under which nature effects a solution is
unknown to scientists.
We shall not speculate just how nature effects either the solution or the
extraction. The simple fact we must keep in mind is that the fluorides manu-
factured artificially are totally different in their toxic activities. They are
infinitely more poisonous and destructive to life than the fluorides referred to
as "natural."
With this as an established fact; the great opposition to what is represented
as fluoridation is the thought of permitting authorities to substitute the com-
mercial grade of raw fluorides and dissolve this in the public drinking water
in lieu of the "natural" or "conditioned" fluorides. The purpose of this bill is
to prevent and make it illegal or unlawful for anyone to dissolve any compound
containing fluorine in the drinking water : and it is on this account that I request
that this committee approve the resolution in question and recommend to Con-
gress its passage.
Doctors of medicine authorized to practice are familiar with the therapeutic
effects of drugs and medicines as well as toxicology and dosage. In a period of
many years of practicing pharmacy, I have not come across any record or found
any evidence showing that doctors prescribe or make use of any fluoride compound
as an internal medicine. The literature is quite extensive concerning fluorides
but is practically silent when it comes to describe its therapeutic value for human
ingestion — the safe does that can he taken internally without serious or harmful
result. But every medical man knows that to obtain the greatest result from
any drug or medicine it is important to remember, especially in connection with
fluorines, that more fluorides will be retained if It is given in small multiple
doses than when a similar quantity is given in a small number of larger doses.
A great deal has been written about the quantity of fluorides proposed to be used
and that the individual dose is exceedingly small and on account of that no
deleterious effect is found. It is proposed to limit the quantity to 1.2 parts per
million, which is considered infinitestimal, but it is well for this committee to
remember that the highest authorities in the land agree that one part per million
is the cause of endemic fluorosis with a marked tendency to mottling of the
teeth. It is because fluorides like the iodides, the mercurial preparations, and
the salts of heavy metals possess the arbitrary quality of accumulating in the
system, and in the case of the fluorides, they will combine with the calciiim in
the bones and teeth and finally flow over into the soft tissues with injurious
consequences.
The introduction of this legislation is intended to meet the challenge of the
Department of Health, Welfare, and Education, which will be referred to here-
inafter as the Federal Board of Health, as this is the bureau that is responsible
for the introduction on a national scale any fluoride compound to be dissolved
in public drinking water and commonly referred to as "fluoridation." It is a
proposal introduced simultaneously with the former administration's attempt to
introduce to America a policy which has become recognized as "socialized
medicine." In the beginning, it was not the intention, however, to introduce
the fluorides in the public drinking water or make it compulsory that every indi-
vidual be obliged to consume the drug. The first original attempt to use the
raw fluorides was described in one of the public documents, GPO-O-813330.
This was a method of using a fluoride tlierapy not by feeding it to the child as a
sodium fluoride solution but was recommended for topical application, and the
literature stated that "for the first time in history a practical method for the
prevention of teeth decay that can be applied on a group basis has been intro-
duced. Tests so far have shown that out of every 10 teeth that might otherwise
decay, 4 may be saved by a new preventive method." Apparently, it had not yet
been called to the attention of the Public Health Board that the quantity of
sodium fluoride used in tropical application would be very insignificant indeed
and would under no circumstances solve the problem confronting the concerns
burdened with very large waste piles of cryolite residues saturated more or less
with fluorine. Sometime subsequent to the recommendation of the topical use
of fluorides, there was a change in the minds of the members of the Federal
Health Board. Although they had hailed the topical application as the greatest
discovery in history, they quickly united, as the minutes of their meetings
indicate, on selling the American public on dissolving the fluorides in the drinking
water and that every person irrespective of age or physical condition ingest the
fluorides, although they freely admitted that no possible benefit could be derived
by anyone except those in the age group of from 1 to 10 years.
FLUORIDATION OF WATER 231
You will iindersfaud from this statement tlial the proposal of fluoridation is
not in Itself a health measure or a health program as represented. It is pure
politics; and, as such, it has met with considerable success as. according to their
own figures, they now have practically a thousand communities aggregating
some 10 million people daily drinking fluoride solution and consuming foods
that have been cooked in it. It would take too long to recite the dishonesty
and chicancery employed to promote fluoridation, the falsehoods, half-truths,
distortions and evasions, the rigged endorsements and carefully engineered pub-
lic demand. There is evidence to show that the proponents of fluoridation have
tried desperately to secure public approval and to put the proposition across
on a grand scale before the people realize the inherent dangers in the whole
evil undertaking.
The first step was apparently to set up a plan which would conceal the true
facts from the public and lend it a veneer of respectability by instituting sev-
eral proving grounds or test areas wiiereby after 10 years they could prove con-
clusively that fluorides in the drinking water were beneficial and reduced the
incidence of caries in the young age group. But even with this small attempt
there arose considerable public opposition. Consequently, the Federal Health
Bureau, instead of waiting for the results of the 10 years" experiments and
trials, began to forcibly introduce fluoridation on a national scale. For this
purpose, they made the various State boards of health and dental associations
not only their ready tool to carry out their sinister purpose, but the boards
of healtli and dental associations became their captives and have been working
hand in glove with the Federal Health Bureau in their effort to fluoridate the
American public. There are, of course, a great many individual dentists,
prominent men, who are opposed to this form of mass medication. Many of
them have dared to voice their opinion and hostility to the whole program.
They have helped greatly to arouse the public against the whole plan.
It has not been brought to our attention that any of our State board of
liealth or the Federal Bureau has ever made a definite statement that by ingest-
ing daily a fluoride that anybody past the age of 12 or 15 years could or would
receive any or the slightest benefit from this medication. When you take into
consideration that only 5 percent of the Nation's public water supply is used in
the kitchen for cooking or for drinking, and as only the children between the
ages of 1 to 10 admittedly are the only group that could receive any benefit,
it means that only half of 1 percent of the total fluoride used can be used eft'ec-
tivel.v. In other words, out of every $100 of tax money TiO cents will be used
for the proponents' good purpose — the balance, $99.50 will be wasted and go
down the drain.
Although this may seem like a terrific waste of public funds, the American
people would be willing and could well afford to do it providing they were
assured of definite benefits for their children or for themselves. Unfortunately,
that is not the ca.'^e : but. instead, we have embarked upon a program that vio-
lates man's greatest experience, viz to keep the public water supply pure,
wholesome, and potable. Fluoridation is mass medication on a grand scale
ostensibly to accomplish a reduction of the incidence of caries of the very
young, but it is mass medication and provided it is found to be legal or not
made illegal, we may then have opened the way to use the various public
water supplies througliout the coimtry for further experiments in medication
in such well known human ailments as rheumatism, high blood pressure, dia-
betes and anemia.
In order to save space, or rather for lack of space, the customary method of
inserting the origin, the documentary evidence or reference after each state-
ment or paragraph, I have reluctantly disi>ensed with, but will supply upon
request to proper parties the origin and full authentic information concerning
every statement made.
The following facts appearing below are taken from :
Investigations and research by physiologists and biochemists, professors of
medical colleges, M. I. T., engineers.
The hearing before Hon. Dr. Miller and other Members of Congress.
Opinions and court decisions and testimony by experts and scientists at trials
in the courts of law.
Reference books, medical literature, documents, scientific papers, medical
dictionaries, encyclopedias, pamphlets, booklets, scientific articles, United
States dispensatory.
Books on chemistry, pharmacological therapeutics by Drs. Goodman and Gil-
man.
232 FLUORIDATION OF WATER
Papers from Professor Taylor of the University of Texas, Dr. Cristinai, Drs.
Smith of Tucson, riz., Charles Eliot Perkins, Washington. D .C, biochemist.
Dr. Charles A. Brusch of the Cambridge Medical Center, Dr. V. O. Hurme of
the Forsythe Infirmary, Dr. Leo Spira of New York.
"Sodium fluoride is a general protoplasmic poison."
"Hydrofluoric acid produces a vesication and deep, progressive destruction of
tissue."
"Dangerous symptoms have been reported in man from 0.25 gms. of sodium
fluoride."
"Fluoride poisoning tends to lower the calcium of the plasma."
"Fluorides are strongly inhibitory to some enzymes."
"The addition of 0.4 percent of sodium fluoride renders shed blood non-
coagulable."
"Sodium fluoride depresses the respiration of finely divided muscles."
"Lipase is inhibited by N. A. F. 1 : 5000."
"It is toxic to nerves."
"Endemic fluorosis is a serious problem in Argentina."
"It lias not yet been demonstrated that the addition of raw fluorides to the
water supply has the same effect on children living continuously for the first 12
years of life in fluoride areas."
"If caries do start in mottled teeth it spreads rapidly."
"The changes in human teeth consists of chalky white patches often pitted and
eroded."
"Bone changes are seen especially with industrial exposure to the dust of
cryolite or phosphate rock."
"Nonfatal doses when ingested continously cause general cachexia and in-
hibition of gi'owth."
"In lower animals, analogous changes occur in teeth and the bones become
hard, fragile, or brittle."
"Marconi reported severe acute parenchymatous nephritis or chronc poison-
ing of guinea pigs with fairly large doses of fluoride."
"Fluorine is not and cannot be effectively used for the purpose of sterilizing
the water."
"It remains in the water and a rise in temperature accelerating evaporation
leaves the fluorine unaffected and increases the concentration."
"Fluoridation will not cure dental caries nor preA-ent it entirely even in the
young-age group which it is designed particularly to serve."
"We cannot escape the conclusion that fluoridation is a form of medication."
"Damaging to the brain and nerve cells."
"Harmful to the reproductive organs with the resultant lowering of the birth
rate."
"Affects the thyroid gland and damages the liver."
"Creates a high incidence of bone fractures."
"Some of the highest life expectancies are reported from the regions of the
globe with the least fluorine in the soil or water."
"There is no disagreement about the fact that fluorine is a protoplasmic
poison."
"Since nerve function is not completely independent of the influence of
calcium exchange, and since the intake of fluorine, in turn, has some influence
upon the utilization of calcium, it would seem that there is a good theoretical
basis for instituting upon some study of the role of fluorides from the neurol-
ogists' viewpoint."
"Fluorides are violent poisons to all living tissue because of their precipitation
of calcium."
"They cause fall of blood pressure, respiratory failure, and general paralysis."
"Since all living processes occur in matter in the colloidal state, many patho-
logical conditions, even probably insanity, results directly from disturbance of
the colloidal state."
"It is an established fact that the fluorides cause breaking down of protein
and disturb the colloidal state."
"To me it is unthinkable that the Public Health Service should recommend
universal medication of water for everyone."
"I have repeatedly produced clear and conclusive evidence that proves fluorine
can and does play an important part in promoting the first stage of cancer and
in accelerating the second stage."
FLUORIDATION OF WATER 233
"The results show no change in the incidence of cancer, but rather indicates
a shorter life span in the mice receiving the fluoridated water."
"The effect of fluorine on the human body is very little known."
"The scientific knowledge is very limited."
"The main thing to remember about fluorides is that they are protoplasmic
poison, and they have never been medically approved."
"Extensive pharmaco-dynamic research from reliable sources leaves us speech-
less when we think of a plan to fluoridate the water of the entire Nation."
"It can only be classified as mass murder."
"These are some of the important conclusions: Sodium fluoride in small re-
peated doses may affect digestion by interference with enzyme action."
"May affect heart muscles by alteration of the heart solutions, calcium change."
"May affect urinary tract and eventually cause uremia."
"May give rise lo aplastic anemias, causes incoagulability of the blood, attracts
calcium."
"May cause serious bone change, precipitation of calcium."
"May induce many serious and varied nervous manifestations."
"Cause psychic and motor disturbances."
"All individuals may be allergic to some * * * that allergy is a biologi-
cal alteration of the cell protoplasm. Fluorides are classified as protoplasmic
poisons."
"Fluorine affects all parts of the body causing hardening of the tissues, osteo-
malacia of the bones, otosclerosis of the ears, sclerosis of the arteries."
"The toxic aft'ect of fluorine increases as the temperature rises, a fact that is
noted in the pami)hlet of the American Dental Association."
"Since fluorine plays no useful part in human metabolism, it is false to claim,
as some advocates do, that failure to put fluorine into the drinking water deprives
children of something they need."
"Artificial fluoridated water tends to aggravate condition in people afflicted
with goiter."
"It is the conclusion of reputable physiologists that the total effects of fluorine
upon the human system is harmful."
"Mass medication of the whole population by means of fluoridation does not
take into account the fact that every human being differs from evei"y other, and
what may not seriously harm one may kill another."
"High humidity increases the toxic effect of fluorine."
"The commercial inorganic sodium fluoride or fluosilicate contains minute
quantities of many other ingredients."
"It is safe to say that fluoridation is mass medication without parallel in the
history of medicine."
It would be possible under the circumstances to continue listing objections of
vital importance against the use of fluorides in any quantity whatsoever. I want
to repeat that fluoridation is definitely not a health program ; it is political in
every sense of the word. The Public Health Bureau has prostituted its high
office and has embarked on a program which, if carried to its ultimate, might
endanger the health and welfare of the whole Nation.
Placing of vast quantites of a deadly poison adjacent to or in close proximately
to the public water supply is in itself filled with the greatest risk ; and, it is the
opinion of a vast number of people in America that such quantity of poison,
with its great potentiality for damage and permanent harm, should be forbidden
by Federal law.
I respectfully submit the above for your consideration.
Law Offices, Charles C. Deubel, Jr.,
Newark, N. J., May 15, lOSJf.
Hon. Charles xV. Wolvertox,
House Office Building, WuHlxinnton, D. C.
Dear Sir : I am greatly concerned over the fluoridation of our drinking water.
I have opposed it locally (I am a village trustee at South Orange, N. J.) and will
oppose it statewide and nationwide because I am fearful of it from a national
security point of view.
I have studied this fluoridation for the purpose of making a decision on it for
my community, and I can't understand the great pressure for its advocacy by
governmental agencies and dental societies. I an* suspicious of this pressure.
234 FLUORIDATION OF WATER
If it were such a good thing theu pressure would not be needed. Why, why there-
fore, are the proponents trying to force it upon an unwilling and in most cases,
an unknowing ijublic?
First of all, if I or any other citizen believes that fluoridation is good for his
children's teeth, we can go to any dentist and have it applied or a treatment
rendered. Why, if I can do this, de we have to force it on all of the public?
Secondly, fluoride is a poison and while allegedly not deleterious immediately
in the portions advocated for use, it is certain that an overdose is lethal. Why
risk a lethal poison in our water systems? That is giving our enemy the oppor-
tunity of poisoning and killing thousands of our people with the one bullet of an
overdose of fluoride in our water systems. This thought disturbs me no end.
During the last war I was an apent in the Counterintelligence Corps. One of
our jobs was security of our military installations. In that our first concern
was always the water tower and/or water distribution system. With fluoride
readily available, and with the machinery set up for its entry into the water
systems of the Nation, we would have a national seciu-ity risk far greater than
the atom bomb. How can we be so foolish as to give our enemy such an ad-
vantage? The overpowering of the man in charge of entering the fluoride into
the system, the infiltration of an enenty into that .iob, or the surreptitious entry
of an overdose of fluoride into our water would kill half of our population before
we knew what was wrong because it cannot be detected, it has no smell and has
no taste.
Thirdly, putting this security ri.sk aside for the moment, consider what the
toxic effect of fluoride even in the .small amounts advocated, will have on our
people in 10 or 20 years hence. No one knows. The tests to date do not prove
that it will have no deleterious eft"ect. It is only in an experimental stage.
We must positively know that it will not have a deleterious toxic effect on one
single citizen. Unless we know this, we cannot risk it by impressing it on all
citizens.
I say, if people want it, let them go to their own dentist to get a treatment, but
do not force it on all people for the alleged benefit of children just getting their
second teeth. How can we ever justify these grave national risks when only a
segment of our child population could possibly benefit and when even that
benefit is not proven conclusively?
Please give serious consideration to these things. Sure, you and I are both
for progress, but certainly not at the risk of people's health and lives.
Please support H. R. 2341 which will outlaw the use of fluoride in water for
general use in hospitals, post offices, and military installations.
Please vote against H. R. 7397 which would give the Surgeon General a free
hand over the u.se of fluoride. This could lead to national disaster.
Respectfully yours,
Charles C. Deubel, Jr.
Medical Evidence Against Fluoridation op Public Water Supplies
(By George L. Waldbott, M. D., Detroit, Mich.)
Note. — Dr. Waldbott has published more than 100 scientific papers on
original research on various phases of allergy, and one book entitled
"Contact Dermatitis." Dr. Waldbott is the vice president of the Amer-
ican College of Allergists, a Fellow of the American College of Physi-
cians and of the American Academy of Allergists, as well as of other
national and international societies in his specialty.
Health and dental groups introduced the project of adding fluorides to the
domestic water supplies because a lowered incidence of dental caries was ob-
served in areas where fluorides occurred in the water naturally.
May I preface my remarks by explaining why I am interested in this subject.
As an allergist, I have seen much serious trouble in allergic patients caused
by indiscriminate medication. Moreover, the opposition to fluoridation has thus
far depended largely iipon nonprofessional people for leadership. In general,
coonpetent medical men have either been too busy or have not yet given the
problem adequate attention to oppose the powerful groups pressing fluorida-
tion. Naturally, the view of a practicing physician like myself differs from
that of health officers, research people and dentists.
FLUORIDATION OF WATER 235
In this controversy two facts must be acknowledged from studying the avail-
able literature: First, this drug has a tendency to settle in the tooth enamel
rendering it denser, harder, and more resistant in children under the ages of
10 to 12. However, whether this actually means healthier teeth has not been
proven. Second, in the concentration in which fluorides are being added to
drinking water, they are not likely to induce acute fulminating poisoning. How-
ever, the probability of chronic poisoning will be discussed at length later. Do
these two facts justify the -calculated risk" of which the proponents of this
plan speak when they require every individual in the community to drink water
containing fluorides, rather than to permit dentists to prescribe the drug when
they consider it necessary?
l' shall discuss the medical aspect of the fluoridation problem by elaborating
ui)on the following points:
1. Can there be a "safe concentration"?
2. Is the value of fluorides scientifically proven?
3. Is there danger of disease and death from fluoridation?
4. What methods are being employed in some scientific circles to promote this
program ?
There are many political, social, and legal aspect involved in the controversy
upon which I shall not touch.
I. SAFE CONCENTRATION
From animal experiments and statistical studies in humans, the proponents
of the plan conclude that a concentration of 1 part of sodium fluoride in 1 mil-
lion parts of drinking water by weight (1 p. p. m.) entails no harm. Accord-
ing to dental research authorities, mottling of the tooth occurs at 0.7 p. p. m.
and a mottled tooth is a poisoned tooth. Therefore, how can the concentration
of 1 p. p. m. be called "safe"?
If animals are fed diets containing 7 to 12 p. p. m. the first signs of poison-
ing begin to appear. The incisor teeth become chalky, pitted, and corroded.
The bones and kidneys show minor degenerative changes.
Other findings are damage to the liver, to the stomach and bowels, and to the
tissues surrounding bones and teeth. The animals loose their appetite, they
may develop anemia and brain disturbances. (1.)
When fluorides are taken into the system through ingestion by mouth, a large
portion reacJies the bloodstream by penetrating the mucous lining of the intes-
tinal tract. It is then distributed by the blood to bones, teeth, kidneys, liver,
spleen, brain and other organs where about 10 percent is retained for many weeks
or even months. (2.) The remaining 'JO percent is then eliminated from the
blood mainly through the kidneys in the urine and through the skin in the sweat.
Reactions in the human body differ from those in a test tube. Every single
phase of the above metabolic process is subject to tremendous individual vari-
ations. Blood samples, for instance, of individuals in the artifically fluoridated
city of Newburgh showed variations of as much as 900 percent (3.) in spite of
the attempted regulation of the "safe" 1 p. p. m. intake of fluoridated water.
There are many reasons why this intake of 1 p. p. m. cannot be properly
controlled and maintained in a person drinking such water. What, for example,
about simultaneous ingestion of fluorides in food? Tea, for instance, contains
30 to 60 p. p. m. For a habitual tea drinker, therefore, this drink would
bring the daily intake of fluorides just within the safe limit. If, in addition,
he were to eat food grown in a fluoridated area which contains much larger
amounts than usual, and if this food were boiled in fluoridated water, thus concen-
trating the fluorine content further, the intake would most likely reach toxic
levels. Furthermore, if an individual has diabetes or a disease accompanied by
fever his water intake could rise so much higher that this might conceivably
decide the course of his illness.
The amount of fluorides absorbed from the bowels is greatly influenced b.v
the acidity of the Iwwel content. Furthermore, sodium fluoride which is added
to the water supply is much more soluble than organic compounds containing
fluoride present in water of naturally fluoridated areas. Therefore, much more
will be absorbed through the bowels under the artificial scheme than in an area
where it occurs in nature. The condition of a person's teeth, bones, kidney,
liver, and brain — especially their calcium content — determines how much fluorine
is retained in these organs. Thus, under certain circurstances the 10 percent
figure of fluorine retention may be considerably exceeded.
48391—54 IG
236 FLUORIDATION OF WATER
The elimination of the fluoride salt through the liidneys is of special impor-
tance for a patient with a diseased nonfunctioning kidney. ]Much less can be
eliminated; in other words, much more is retained in his system for potential
development of toxic symptoms. There is a great lil^elihood of extensive damage
from this salt in elderly individuals who notably have a tendency to arterio-
sclerotic, poorly functioning kidneys. What will happen to such individuals
after drinking such water year after year can only be imagined. Finally, there
are further individual differences in the event that a person is allergic. I
should like to refer to my own experimental work published a year ago on
"Drug Tolerance in Asthma" (4.). It was demonstrated that an asthmatic
patient may be poisoned by otherwise harmless doses of any given drug. I am
not referring here to allergic symptoms, but to true poisoning from otherwise
harmless amounts of such drugs. This was observed clinically and proved
exijerimentally. One cannot escape the conclusion that there may be consider-
able damage to a large part of the population from artificially fluoridated water
in the so-called safe concentration of 1 p. p. m. for everyone in an entire
community.
II. APPBAISAI. OF THE VALUE OF FLUORIDATION
In their pamphlets the health authorities promise a 63 percent reduction in
dental caries if fluoridation is adopted. This figure is derived from statistical
studies in sucli fluoridated cities as Grand Eapids and Newburgh. The teeth of
school children drinking this water were examined and the number of cavitiess
recorded periodically. This evidence is not accepted by some leading dental
research authorities. Hurme (5), for instance, points to the many pitfalls in
compiling statistics of this kind, especially to the lack of standardization of
the methods employed, to the personal bias of the examiner, and to the relatively
short period of observation.
Let me give an example of the confusion : IMottling of teeth is commonly found
in fluoridated areas and is identified with beginning fluoride poisoning. (6.)
Most proponents of fluoridation consider a mottled tooth aesthetically unde-
sirable rather than diseased. Such a divergence of opinion is bound to affect
the statistical appraisal of healthy teeth, and this alone renders the statistics
inadequate. In addition, Boyd and Wessels (7.) state that repeated examina-
tions of the same tooth made by the same examiner at different times may
result in a different interpretation from one examination to another.
Furthermore, children who have periodic examinations of their teeth are
usually at the same time alerted to the importance of good dental hygiene, good
nutrition, and elimination of sweets and soft drinks.
Finally, most statistical reports disregard the observation of such thorough
students of the subject as Smith and Smith (S). They found that individuals
in fluoridated areas, who as children showed an apparent x'eduction in dental
caries, after they had passed the age of 21 manifested much more extensive
deterioration and weakening of the tooth structures than those in nonfluoriilated
areas. A similar obseiwation is related by Newman (9.) in two suburbs of
Sheffield, England. He and other observers have noted in various publications
that people in areas where the water is practically fluorine free have excellent
teeth. Therefore, the 63 percent reduction in caries from fluoridation of water
is not substantiated.
III. HAZARDS OF FLUORIDATION
Why are there no reports of disease and deaths from fluoridated water? In
distinction from acute poisoning, symptoms of chronic fluoride poisoning ai'e
vague and insidious. Nausea, general malaise, joint pains, decreased blood
clotting, anemia, and similar vague symptoms may result from a variety of
causes and do not represent a clearcut disease syndrome. Even an exti'emely
well-trained clinician is not likely to make the correct diagnosis. When a patient
finally succumbs to a kidney or liver disease, it is practically impossible for the
average physician or pathologist to trace the disease to its true cause. Health
authorities and some dentists do not take this into count. Indeed, in two munici-
palities of metropolitan Detroit, physicians are so little aware of this problem
that I found hardly a single doctor who knew that he, personally, was drinking
fluoridated water.
Shouldn't we expect a significant rise in the death rate from kidney, liver, and
brain diseases in fluoridated ai*eas if there is chronic intoxication from poison-
ing? First let us consider that such diseases and death in naturally fluoridated
areas are much less likely to occur than in artificially fluoridated ones because
FLUORIDATION OF WATER 237
of the above-mentioned lower solubility of organic fluorides as compared to
sodium fluoride. Furthermore, vital statistics on diseases which are difficult to
diagnose, notoriously furnish very unreliable information. I personally observed,
in reviewing deaths from bronchial asthma, that the majority of deaths recorded
in death certificates represented asthmalike wheezing from other sources. Simi-
larly, without an autopsy even the most expert clinician would find it extremely
difficult to establish the diagnosis of fluorine poisoning. There is evidence which,
however, cannot be fully corroborated because of insufficient published infor-
mation that Grand Rapids deaths from kidney, heart, and brain diseases have
increased since 1945 (10).
The benefits derived from fluoridation have been compared with those from
penicillin. In 1949 I reported the first death from penicillin ever reported in
literature (11). Since that time nearly every general practitioner, certainly
every allergist, has observed serious reactions, near deaths, and even deaths
from this drug. I recognize the value of penicillin as much as anyone ; I use
it extensively in my practice ; however, like other competent physicians I am
against its indiscriminate use. Assume, for instance, that this otherwise harm-
less drug were given every day to everyone in the country in very small doses
for prophylactic purposes. Based on my extensive studies on human anaphy-
laxis which were carried out in 19.">.")-36 (12). I would have to conclude that
the results would be disastrous. Similarly, it will take many years and much
careful and thox'ough clinical observations by competent physicians to evaluate
the potential harm of fluorides. I predict that once the first fluorine death is
reported, others will be recognized in rapid succession.
I have attempted to set forth why there can be no such thing as a safe con-
centration, why statistical evidence concerning the benefits of fluoridation is
unreliable, and why thus far no serious illness and no fatalities from this cause
have been reported. Whereas I have endeavored to keep this discussion on a
factual basis, I cannot help but refer to the method used by health and dental
authorities in promoting this program and smothering opposition.
IV. HOW THE FLUORIDATION PROGRAM IS PROMOTED
In practically all the voluminous literature on the subject hardly a paper is
published which does not capitalize on the fact that there is no organized med-
ical opposition. "No scientific point of view" (13). "Persons misled either
by emotional prejudice or by lack of knowledge" (14) .
In a very informative article issued by the Commission on Chronic Illness
(15), such leaders of the profession as K. F. Maxcy, E. J. Stieglitz, and N. Shock
present throughout the text the safety of the fiuoridation project as an incontro-
vertible fact. In their last paragraph, however, there is the inconspicuous note
"evidence does not absolutely exclude the possibility of risk."
Heyroth, of the Kettering Institute (16), another stanch proponent of fluorida-
tion, assembles all the available data on the possibility of toxicity from fluorides
in an excellent contribution. The author sets out to convince the profession
of the safety of fluoridation, yet at the end of the paper he makes a plea that
evidence of toxicity in patients with chronic nephritis be sought. He recom-
mends that such patients should buy nonfluoridated water if residing in a fluori-
dated community. He disregards the well-known fact that many patients are
ignorant of suffering from this disease.
Practically all publications convey the impression to the reader that dental
caries are primarily the result of lack of fluorides. Even if lack of fluorides
in food and water were to play a part in the production of caries, the fact
remains that such other causes as dietary digressions, lack of vitamins, gland-
ular deficiencies, allergies, and many other factors are equally, if not much more,
responsible.
In an attempt to prove the harmlessness of fluoridation, many of the articles
claim that fluorine is a trace element necessary to good human nutrition similar
in action to iron in forming red blood corpuscles and to iodides in counteracting
goiter. This is contradicted by numerous sources (IT).
None of the papers mention the excellent work by Taylor (IS) who fed fluorides
to a large number of mice in the so-called safe concentration. They developed
cancer much sooner than the control group which was fed a fluorine-free diet.
Also ignored is the woi-k of Harris (19) wliich proved that hamsters fed corn
and milk from Texas developed only half as much dental caries as those fed
corn and milk from New England. His work clearly indicates that not lack
of fluorides but vitamins were involved in the reduction of dental caries.
238 FLUORIDATION OF WATER
All this data indicates that most of the evidence presented by the proponents of
fluoridation on the question of safe concentration, possible danger and on its
value in preventing tooth decay is not convincing.
Why is tliere so little medical opposition to fluoridation? Fn-om personal con-
tact with competent physicians and dentists, I know that there is a strong
potential opposition. These never, however, wonder why scientific medical
organizations officially endorse the program. I am told by a member of the
house of delegates to the AMA who attended the meeting at which the principle
of fluoridation was endorsed by tliis body that he personally was not informed
snfBciently in advance to carefully appraise its drawbacks. He states that the
vote was taken so precipitously that there was little chance to oppose it.
Further you know that "the councils on pharmacy and chemistry of the AMA
purposely refrained from making any recommendation that communities support
or oppose projects for the fluoridation of water supplies." "The house of dele-
gates did not urge or recommend that any communities undertake to fluoridate
their water supplies." (Quotation from the statement of the AMA.)
Other physicians are overwhelmed by the vast repetitious information pre-
senting the proponent aspect and puzzled by the absence of opposition. For in-
stance, at present every member of the American Academy of Pediatrics is
receiving a propaganda pamphlet — not a scientific paper — advocating fluorida-
tion. This is likely to result in another endorsement of a scientific group. Fur-
thermore, they cannot find literature against fluoridation in competent medical
and dental journals. It is evident that conventional dental publications do not
accept scientific material representing the other side. For such information
one is obliged to search in second-rate journals. Moreover, doctors scientifically
qualified, hesitate to oppose the project lest they jeopardize their standing among
colleagues, their practice, and their medical appointments. They do not want
to be identified with those who oppose the project on religious, political, and
emotional grounds.
Let me conclude by reminding you of what happened in the early twenties. A
drug much less harmful than sodium fluoride, namely, sodium iodide, was added
to the public drinking water of some Michigan communities for the i^revention
of goitei-. McClure and coworkers (20) soon noted a marked increase in the
incidence of mortality from toxic goiter among those disposed to it. Immedi-
ately the health aiithorities who had promoted this scheme made iodine
available in table salt instead. Now, anyone can partake of it or not according
to his need.
Why do we not follow this example? Fuorides are now available to be taken
as a tablet in water or milk, or they can be painted on the teeth of those who
wish to avail themselves of their benefits. At present, neither the benefit nor
the safety of fluoridation of water supplies are sufficiently proven to warrant
experimentation with human life.
BIBLIOGRAPHY
1. Review bv Rapp. G. W.. the Pharmacolog>- of Fuoride, The Bur, April
1950.
2. Smith, F. A., et al.. Journal of Dental Research, 29 : 596-000. 1950.
3. Brandl, J., and Tappenier, H. : Zyschr f. Biol 28 : 518, 1891-92.
4. Waldbott, G. L., Drug Tolerance in Asthma, Ann. of All. 11 : 199-203, 1953.
5. Hurme, V. O., Forsythe Dental Infirmary for Children, Boston, Mass.,
Dental Items of Interest, June 1952.
6. Smith, M. C, Arizona Experimental Station Technical Bulletin, No. 329,
August 1938.
7. Bovd, J. D., and Wessels, W. E., American Journal of Public Health
(41:976-985, August 1951).
8. Smith, H. Y., and Smith, M. C, Arizona Experimental Station Technical
Bulletin No. 43, 1932.
9. Newman, H. H., New York State Journal of Medicine, 51 : 1749-1752, July
3951.
10. Miller, A. L., Congressional Record, March 24, 1952, A1899-A1904.
11. Waldbott, G. L., Journal, AMA, 139 : 526, 1946.
12. Various publications on human anaphylaxis published by the author in
Journal, AMA, American Journal Diseases of Children, Journal of Allergy.
13. Wertheimer, F., Journal Michigan State Dental Association, 36 : 131-135,
May 1954.
FLUORIDATION OF WATER 239
14. Kuutson, J. W., New England Journal of Medicine, 246-737-743, May
1952.
ir». Chronic Illness New Letter, volume 5, No. 4, April 1954.
1(5. Hevroth, F. F., Americnn Journal Public Health, 42 : 1568-65, 1952.
17. (a) Food and Drug (Dental Digest, New Jersey, F. D. C, 3381-3383),
August 1951.
(h) McCoUuiu, E. v., et al., the Newer Knowledge of Nutrition, MacMillan
Co.. 1938.
18. Taylor, A., Dental Digest. April 1954.
19. Tarris, li. S., quoted by McCormick, W. J., Arch, of Ped., April 1953.
20. McClure, R., et al.
Citizens Medical Reference Bureau, Inc.,
Neto York, N. Y., May 24, 195.'t.
Hon. Charles A. Wolveeton,
Chairman, Committee on Interstate and Foreign Commerce,
Congress of the United States, Washington, D. C.
Honorable Sir: We thank you for your letter advising of the hearings on
H, R. 2341, known as the Wier bill, beginning Tuesday, May 25, and running
through Thursday, May 27.
While other commitments will not permit of us attending on such short notice
we wish to go on record as approving the AVier bill. It is a positive effort to
assure the medical freedom of the people of this Republic, which is being seriously
threatened on every side by the proponents of fluoridation.
The Wier bill is an absolute necessity in the face of the elastic law of the Pure
Food and Drug Administration, which permits of too much freedom in the
application of the law within the discretion of the administrators. It is this
weakness in the law which is being invoked by municipalities, which have forced
flluoridation upon communities without benefit of the ballot :
"The Pure Food and Drug Administration has accepted the findings of the
United States Public Health, that 1 part per million of fluoride added to the
drinking water is harmless."
Those who have done the most research with fluoride, among them Drs. Leo
Spira, of New Ydrk : V. C. Exner. of Seattle, Wash., and Dillon, of Scotland,
hold a diametrically oppositive view.
The fluoridation of the potable water supply is to say the least, a contro-
versial issue, as any physician or dentist who has taken the time to review the
available literature on the subject will be obliged to admit.
Fluoridation nf the public water supply is strictly individual treatment
in mass operation: it is iirescribing medicine without benefit of diagnosis or
individualization of dosage ; it is a treatment and not a sanitary or hygenic
measure ; it can no more l)e condoned than would be the medication of bread or
butter to prevent a disorder of the physical organism.
There is ample provision in medicine to satisfy the mothers and fathers of
children who wish to have the teeth of their offspring treated with fluorine with-
out placing the health of the entire population in possible jeopardy or to compel
them to accept medical treatment without desire or consent.
Fluoridation is unquestionably mass medication in its most vicious form —
that of compulsion : further, it is a direct step in the socialization of medicine.
As a national organization representing the voice of 70 million people who
revere medical freedom as guaranteed to the people of the Republic, we wish
to go on record as approving the bill H. R. 2341, known as the Wier bill, designed
to forbid by Federal statute the fluoridation of the potable water supplies of the
Nation.
Our background of 35 years' experience in dealing with the problem of com-
pulsory medical legislation in the interest of preserving medical freedom, we
believe, qualifies us in matters of this kind.
We submit that in all or long experience nothing as directly compulsory
involving the whole Nation has come to our attention, and considering the great
power that is being brought to bear by the United States Public Health Service,
the passage of the Wier bill, is indeed urgent.
We, in the name of medical freedom and liberty plead that the Wier bill be
passed, and ask that our wholehearted approval go on record.
Respectfully submitted.
PlERREPONT E. TWITCHELL,
President.
240 FLUORIDATION OF WATER
Washington, D. C, May 27, 195',.
Re H. R. 2341, Antifluoridation.
Hon. Charles A. Wolverton,
Chairman, Committee on Inter' state and Foreign Commerce,
House Office Building, Wasliington, D. C.
Dear Sir : We, the people, do not want fluoridation in our drinking water. I do
not talie medical drugs of any kind, and I do not want sodiumfluoride — rat
poison — in my drinking water. They are putting it in the water, to make profits
for the huge aluminum trust, the medical trust, the chemical or drug trust, and
the equipment makers.
From the Congressional Record of March 24. 1952 : "A clieck of vital statistics
of Grand Rapids, Mich., which is the only city of size that has had artificial
fluoridation for more than 4 years, shows that the death rate has increased 50
percent in this time ; from heart trouble, 50 percent ; kidney trouble, 50 percent ;
and brain lesions, 50 percent."
We only drink 5 percent of the city's water supply and the other 95 percent
of fluorine is washed down the sewer. Why should we have to pay the heavy
expense of wasting fluorine in the city water and make ourselves sick by drinking
the poison?
In Dr. Dean's report on May 27, 1954, for the American Dental Association,
they say that when a tooth decays, it is never repaired again by nature, and that
fluorine merely keeps the tooth from decaying more.
If a tooth never repairs the decay in a tooth under a medical dentist, it is
because the dentist knows nothing about nature-cure methods. Mr. Howard V.
Inches, a nature-cure health lecturer, had the enamel blown off his front teeth,
by a buz-bomb explosion in World War II, he said, and he has now grown the
enamel back onto his teeth.
A lady told me she took the enamel off her teeth by using a highly advertised
toothpaste, and that she grew the enamel back on through correct diet — nature-
cure diet. The medical doctors don't know anything about natural diet and don't
want to know. There is no money in keeping people well, it seems.
If people can't get fluorine taken out of the water, they certainly can move
back onto the farms and be safe for awhile, and in the meantime they can vote
out the people who advocate it. I don't think the big property holders would
like that, because the price of real estate will go down when people leave
the cities.
Fluorine is injurious to people, and we are not going to have it in our water,
even if we have to vote the people out who advocate it.
Sincerely yours,
Anna M. Ferguson.
A Comparative Study of Dentistry in Natural Fluoridation and
NONFLUORIDATION AREAS
Data taken from A. D. A. Directory 1947
1. NONFLUORIDATION AREA
Baltimore, Md., with a population of 859,100, had a registration list of 510
dentists. Approximate service, 1 dentist to every 1,684 people.
Out of 510 dentists are listed the men performing specialized work.
1. Oral surgery, 13; 2. Orthodontia, 11 — (deformity) ; 3. Denture work, 10;
4. Children, 3.
2. FLUORIDATION AREA
Houston, Tex., with a population of only 384,514, had a registration list of 285
dentists. Approximate service, 1 dentist to every 1,350 people.
Out of 285 dentists are listed the men performing specialized work.
1. Oral surgery, 12; 2. Orthodontia, 20 — (deformity); 3. Denture work, 8;
4. Children, 2.
These figures and facts prove the detrimental influence of the fluoridation
program.
Take Colorado Springs, Colo., with 75 years of background, published in May
A. D. A. Bulletin of Information, with the population of 37,789 with 46 dentists ;
ratio approximately 1 to 800 people. Hereford, Tex., with population 2,584
FLUORIDATION OF WATER 241
with 3 dentists; ratio approximately 1 to 8(X) people. Bethesda, Md., nonfluori-
dation area, population 30,0OU with 13 dentists ; ratio approximately 1 to 1,684
people.
COMMENTS
Is the dental profession interested in saving children's teeth? If so, why
does A. D. A. reiwrt in the two cities of Baltimore, Md., with 510 dentists, and
Houston, Tex., with 285 dentists, a total of 795 dentists with only 5 dentists
specializing on children's teeth? Total population of these 2 cities 1,243,614.
A. D. A.-A. M. A. fluori(hition fantasy is not the answer. Poison never made
a normal, healthy cell and never will. Codliver oil, calcium medication, exer-
cise, fresh air, sunlight and pure water reach into all the haunts of life and
impart that touch of nature, when oheyed, furnishes the open sesame to the
miracle of life.
Geokge J. Brett, D. D. S.,
Lancaster, Pu.
Fluoridatiox — Friend or Enemy — Statement in Support of H. R. 2341 Pre-
sented BY Anthony J. Romeo, President of the New York Statewide
Committee of the Pure Water Association of America
This age of modern living has set up such a terrific pace, we could conceivably
lose our balance in the mad rush to keep up with the world. New ideas and
schemes pop up with such fi-equency, we hardly have time to understand them
all. Consequently, the people of our country could quite possibly commit suicide
by taking a very passive attitude when they should demand complete education
on new developments. This is especially true in cases where the economical
structure of our country or the health of the i>eople is concerned.
Fluoridation is probably one of the greater puzzles of this modern age. Much
has been said about it, and it is surprising how many people have accepted it
as just another step toward easier living, without ever questioning the ultimate
benefits or the dangers. Unfortunately, some of our professional men in high
places have lent their titles and names to the scheme without, in many cases,
making a thorough study of the proposal. Dr. A. L. Miller, Representative from
Nebraska, who took pait in the congressional hearing on fluoridation in 1952
feels that most of the proponents of the plan have done little if any research
on their own and that they are merely parroting one auothers' opinions.
I have found this to be true. Hundreds of people I have talked to seem for
the most part to fit into one pattern. If they are for it, they are poorly Informed
or misinformed. They seem to feel that the doctor so and so is a man of integrity
and could not be wrong. They do not stop to consider that possibly doctor so and
so has been misinformed or as Dr. F. B. Exner has suggested, possibly certain
dentists are being pressured into carrying the ball for the fiuoridators. On the
other hand, I find that those who are well informed on the matter are for the
most part against the practice completely or want more time for sufficient study
on the matter.
In a recent broadcast, one of our top columnists suggested that the 99 percent
assurance of safety for the new polio serum wasn't good enough. Yet a lot of
people who should know better accept fluoridation wholeheartedly when the
percentage of safety leans considerably toward the danger mark.
Fluorine itself is an inorganic corrosive ; a cumulative poison that could hardly
be accepted as an inoffensive element when it is admitted that even a sound and
healthy kidney can only dissipate 90 percent of the effect at its best. What will
happen to those with ailing kidneys, such as people who suffer from uremic poison
for example?
We concede that certain tests are being conducted in Newburgh and Kingston,
N. Y. We are not satisfied, however, that these tests will be conclusive. First
of all, we understand these tests are supervised by proponents of fluoridation ;
secondly, we hear that statistics coming out of Newburgh are not telling the
whole unvarnished truth of the matter.
Let us consider, for instance, the statistics given us by the observers at New-
burgh. It is claimed that there has been a greater reduction in tooth decay
among the children in Newburgh than in the control city of Kingston. However,
in the overall picture, the total defects in children of school age are 100 percent
greater in Newburgh than in the control city, according to the 1952 statistics
of the Department of Education. Why? Could it be that although tooth decay
242 FLUORIDATION OF WATER
is reduced — other defects are induced? Only an honest study can give lis the
answer. One of tlie greatest faults the promoters of fluoridation have is they
want to be heard, but refuse in a great number of cases to allow the opposition
to present its side. This is, of course, a deplorable situation. If, as the promoters
would have us believe, fluoridation is beyond reproach, why then deny the other
side the privilege of at least asking questions?
We believe that the only way to resolve a question is to have both sides present
their cases. Only with all the facts can we be certain of the success of a propo-
sition. The newspapers have in many cases been taken in by the peddlers of
fluorine. This, we can say with conviction, is part of a plan set up at the fourth
annual conference of State Dental Directors with the Public Health Service and
the Children's Bureau, held in the Federal Security Building. Washington, D. C,
June 6-8, 1951. The Parent-Teachers Association was also included in this plan
along with anyone of importance that could be hoodwinked into taking up the
battle cry for fluoridation.
Many communities have been allowed a vote on the subject of whether or not
to fluoridate their community. In many cases, success for fluoridation comes
only when the public had been given but one side of the proposal. Many com-
munities are not even consulted. The city administration puts it in after advice
or harping by pressure groups.
The general feeling of the opponents of fluoridation seems to be that all has
not been told or learned about the plan. That not enough time has elapsed for
study. That it is unconstitutional to force medication upon 100 percent of the
population to partially benefit a very small percentage. That the profluorida-
tors have not told the whole story honestly and truthfully. That they have led
people to believe artifically produced inorganic sodium fluoride is exactly the
same as calcium fluoride as found in its natural state in foods and water supplies.
The protesters of mass participation also hold the conviction that the promoters
are claiming as facts, much data that has long been proven false.
Fluoridation is no different than chlorination, vaccination, or pasteurization is
a claim often held by the advocates of fluoridation. This is without question a very
misleading statement. First of all, you do not have to partake of pasteurized
milk. You can, however, do so by choice. Vaccination is a method of prevent-
ing a communicable disease as is chlorination. Tooth decay is not a communi-
cable disease and nothing can be gained by fluoridation that cannot be gained
much more effectively by at least 10 other methods. These methods are direct
treatments for those who desire them without forcing aged and infirm people to
ingest a poison that cannot possibly help them, but can very readily hurt them.
An amazing fact that disturbs us is why so many dentists and doctors are for
fluoridation while equally qualified medical men are against it. It is incon-
ceivable that both are right. Our explanation is as stated previously. Those
for it, do not have all the facts or are being pushed into it. Those who liave made
a study of it are definitely opposed to the whole proposition.
Many of us are beginning to look at the human race (and I use the term
loosely in the light of recent events) and wonder if it realizes exactly in what
direction it is headed.
Wlien a newspaper or radio station gives free time to proponents but refuses
any time whatsoever to the opponents, then America had better look to its
future with much concern.
The emphasis on children is tremendous. No one is adverse to our children
liaving things somewhat better than their forefathers. But is it necessary to say
to them "All right son. jon can eat all the candy you want now, we have fluorine
in our drinking water"? Have we coddled our children to the extent that we are
willing to shorten the life of our neighbor so that they can have an extra
candy bar?
I would like to ask the promoters this question : Would any one of you fluorida-
lors bare your arm and allow me, a local barber, to inject into your arm a shot of
penicillin, not just one of you but all of you? Reason? There is a little child
up the street. Avho is on the verge of pneumonia and needs a sliot of that drug.
You'll say. "Why should I take it just because some kid has pneumonia?" Well,
aren't you asking us to take fluorine because a kid does not want to brush his
teeth? "But," tlien, you say, "you are not a doctor to go around medicating
people." The answer is, neither is the man who doctors our water supply with
a poison.
Gentlemen, I am going to draw a little parallel here if I may. We have laws
that prevent us from killing or even harming the birds of the air. We protect
FLUORIDATION OF WATER 243
likewise by law the animals in the forests. They cannot be slain out of season, or
at all in many instances. But if a human being is killed in the woods, we call it
an imhappy accident and very seldom punish the slayer with even the loss of his
license. Awhile ago many good Americans made themselves heard way to
Washin.gton when they protested the use of cats and dogs and other potential
pets as victims in medical experiments. We send to jail anyone who dares to
pollute the streams with anything that may destroy the tish therein. The Society
for the Prevention of Cruelty to Animals vigorously brings to task anyone who
dai-es abuse an animal. Gentlemen, would it be asking too much if we beg of you
to treat us at least as the equal of animals of the air and the forests and the
dumb brutes of the farmyard V
A warning was senr out from the Department of Agriculture to farmers, con-
cerning the dangers of using tluorine on bmod sows. Still, who in this great
(Tovernment of ours has sent our an alarm that i)ossihly expectant mothers are
in great danger from the same poison? A few years ago we were hard pressed
to find potatoes that were not half rotted (tr scabby or both. I chanced to call
on a farmer friend of mine. I found him cutting up some of the most beautiful
potatoes I had ever seen. "Sell me some.'" I implored. "Do you want me to go
to jail'.'"' he answered. "These iMitatoes are a cent-a-bag potatoes from the
Government, and I don"t dare take one into my own house to eat. They are for
the pigs." I couldn't help nmsing, "Great country we've got. The pigs eat
better than we do."
I've been told that it is corny to talk patriotism. We have been told not to
use the slightest emotion when a])pearing before this committee. Gentlemen, I
tell you this: Perhaps the fluoridators can stand before you begging to be allowed
to proceed with a coldhearted commercial proposition, hut we who spend our own
money and time and effort (and some of us can ill afford to) speak to you and
implore you to stay the hand of the poisoner and we cannot help displaying the
emotion we feel in our hearts. Who can love or sing or watch a ball game with-
out emotion'^ Can you truthfully say you could face a loaded weapon without
emotion '?
My friends, I onl.v wish you had the great privilege that I have had here in
Washington the last few days. I wish you could be near to these good peoii!e
who came from the far corners of this great country of ours to protect it. They
are men and women with determination and hearts that beat with the tempo
of the marching feet of the soldier who is willing to sacrifice his all that this
coimtry may survive. I don't see doctors, dentists, scientists, housewives and
such in this group. No, gentlemen, I see the little group huddled together at
Valley Forge who so valiantly stood up under terrific hardship and fantastic
odds to shield the neighbor they loved.
On the benches here I don't see Mr. Smith, Representative Brown, or Con-
gressman Jones. I see great leaders and fearless statesmen of old, who had
the courage of their convictions and feared not to speak with truth regardless
of the outcome. You are the people in whom we place our faith. Please don't
let us down. Today we are either surrendering or being relieved of our hard-
earned liberties, one at a time, day by day, year by year, until the democracy we
paid so dearly for will have completely disappeared to high government. This
fluoridation is just another method of taking away another liberty. That is
why we are fighting, my friends, because we feel that a liberty that is not worth
fighting for is not worth having. Please, sirs, we implore you, don't take away
these liberties. Give them back to the people who gained them. Please, gentle-
men, give us back our country.
San Francisco, Calif., Mai/ 5, 195S.
Re Mrs. FriPda Zwerling v. Cify Water Fluoridation
San Francisco Health Service,
City Hall, San Francisco, Calif.
(Attention: Water Department.)
Gentlemen: In January lO.'iS Mrs. Frieda Zwerling, 1865 Oak Street, San
Francisco, came to my office with a very distressing dermatitis of the whole body,
a badly cracked and swollen tongue, painfully inflamed inner cheeks, and deep
cracks at either corner of the mouth.
244 FLUORIDATION OF WATER
The source of this very painful condition was not determined at the moment.
When remedies prescribed failed to relieve, she discontinued drinking the city-
water and in a few days the mouth conditions were healed.
The natural conclusion was that perhaps discontinuing bathing in the city
water might relieve the general dermatitis. This proved to be true with the
exception of slight irritation which entirely disappeared when her garments
were not washed in the city water.
You can imagine the plight of this woman as she is deprived entirely of the
use of city water, and small wonder that she objects to drinking of the poison
that she finds in insect and rat poisons.
The patient also informs me that she finds a great many of our citizens in a
similar plight, which is to be deplored.
Very truly yours,
A. R. Gould, M. D.
P. S. — A brief personal report : I live in Los Altos, spend 4 days a week in my
office in this city and find the frequent washing of my hands in the city water
has for some time brought about a dermatitis which is also deplorable.
Rogers Park, Anchorage, Alaska,
April 19, 1954.
Re H. R. 2341.
Hon. Charles A. Wolverton (Chairman) and Members,
House Interstate and Foreign Commerce Committee,
House Office Building, Washington, D. C.
Gentlemen : A careful 3 months' study of all phases of fluoridation, particu-
larly testimony in hearings before the Delaney committee, conference proceed-
ings. State dental directors with the Public Health Service, Washington, D. C,
June 1951, and correspondence with citizens" groups in many states, including
Scotland, convinces us fluoridation was never intended for the public welfare.
We find a premeditated, concerted, determined policy of deceit, evasion, con-
cealment of facts, and coercion being used by fluoridation proponents, with
spirit of contempt for democratic government, congressional action, constitu-
tional law, and flagrant disregard for individual and public rights and welfare.
We beseech, therefore, that Federal legislation be enacted to prohibit fluori-
dation of public water supplies ; further, that complete investigation be made
into the policies and people responsible for this federally initiated and feder-
ally promoted fluoridation program, including executive personnel of the United
States Public Health Service, Department of Health, Education, and Welfare,
American Dental Association, and any and all other persons or organizations,
w^ho, knowing all facts, continue to pressure communities to fluoridate without
revealing those facts.
It is also respectfully asked that such investigation be carried through to
full, just prosecution of all guilty of this unprecedented violation of the public
trust, rights, and welfare, and maluse of public funds ; further, that careful
scrutiny of public relations policies governing the United States Public Health
Service and Department of Health, Education, and Welfare be made, and action
taken to restore such policies to guidance of moral, constitutional, ethical
principles.
Scores of citizens here join in this request, many of whom, by reason of their
po.sitions and responsibilities, are giving their utmost for the public protec-
tion, health, and security in this area.
Thank you for your earnest consideration of the rights, health, welfare, and
security of Alaskan citizens as well as all under the American flag.
Respectfully submitted.
Mrs. Robert H. Crane.
The Chairman. The first witness on behalf of the opponents this
afternoon will be the representatives of the American Dental Associa-
tion. I would be very glad if those who are present representing that
association will indicate the order of their witnesses.
FLUORIDATION OF WATER 245
STATEMENT OF FRANCIS J. GARVEY, SECRETARY, COUNCIL ON
LEGISLATION, AMERICAN DENTAL ASSOCIATION, CHICAGO, ILL.
Mr. Garvey. Mr. Chairman, my name is Francis J. Garvey, of Chi-
cago, IlL; I am secretary of the council on legislation of the American
Dental Association.
I would like to call the attention of the committee to the fact that
there have been 8 cases decided with respect to w^ater fluoridation,
iind in 7 of them it was held within the police power of the State. If
the committee would desire, I should be glad to file a copy of them for
the record, or otherwise we will ignore it.
The Chairman. I think it would be helpful if w^e might have them.
Mr. Heseltox. What are those cases ?
Mr. Gar^tcy. Kraus v. City of Cleveland (116 N. E. 2d, 779) . These
are all nisi pri United States cases, except one.
The Chairman. Suppose you give the statement for the record.
Mr. Hale. Suppose you give the States in wdiich the cases w-ere
■decided.
]Mr. Garvey. Ohio was the first State. The statement here does
not have the State on it.
De Aryan v. Butler ((Calif.) 260 Pac. 2d, 98 (certiorari denied by
the Supreme Court of California) ) .
That was a case that was heard in an intermediate appellate court
of California, and it is now, I believe, on appeal to the United States
Supreme Court, and it has not been decided.
Kaul against City of Chehalis, Wash., now on appeal, No. 323707
to the Supreme Court of Washington.
]VIcFarlane against Mayor and City Council of Baltimore, decided
in the Circuit Court of Baltimore City.
McGurren against City of Fargo, N. Dak., No. 7368, on appeal to
the Supreme Court of North Dakota.
DoAvell against City of Tulsa, Okla., No. 36,068, now on appeal to
the Supreme Court of Oklahoma.
In each of those cases the district judge decided it was within the
police power of the State, under the prevailing laws of the State, to
fluorinate water in the interest of the public health.
The one adverse decision is the one to which reference has been
made. Chapman against The City of Shreveport, which is now on
appeal by the proponents of fluoridation to the Supreme Court of
Louisiana.
Gentlemen, I w^ill take no more of your time, but would like to
introduce to you Dr. E. Harold Gale, chairman of the council on
legislation of the American Dental Association.
Mr. Heselton. May I ask you what the booklet you have is?
INIr. Garv-ey. This is the appeals brief to the Supreme Court of
Louisiana. If you would be interested in it, I would be glad to make
a present of it to the committee.
Mr. Heselton. I think we would be glad to have it.
(Two of the documents referred to above were submitted for the
record and are as follows :)
246 FLUORIDATION OF WATER
CIRCUIT COURT OF BALTIMORE CITY
Filed November 12. 1952
JAN ROSS McFARLANE AND HARRY 0. HOFFMAN V. MATOR AND CITY
COUNCIL OF BALTIMORE CITY ET AL.
H. Clifton Owens and Louis E. Bowen for plaintiffs
Thomas N. Biddison, city solicitor ; Edwin Harlan, deputy city solicitor ; and
F. Clifford Hane, assistant city solicitor, for defendants
MiTNiciPAL Corporation — Fli'oridation of City Water Supply
Complainants filed a bill of complaint to restrain the mayor and city council
of Baltimore, the commissioner of health, and the water engineer from proceed-
ing with the proposed plan for the fluoridation of the Baltimore City water sup-
ply. Held that the evidence discloses that the ingestion of fluorine in the city
water in the limited qiiantity proposed would not be deleterious to the health
of the people of Baltimore City, and is not a calculated risk of any kind.
One of the complainants challenged the constitutionality of the proposed pro-
gram on the ground that the introduction of fluorine into the water would com-
pel him to violate one of the basic principles of his religion in that it would
force him to use medication. Held that none of the constitutional rights of the
plaintiff, Hoffman, to freedom of religious belief would be invaded or violated
by the adoption of the proposed program.
The mayor and city council of Baltimore has the authority under the city
charter to authorize the commissioner of health and the water engineer to carry
into effect the fluoridation of the city water supply as a health measure for
the prevention of partial decay of teeth.
Manixy, J. (orally) :
The purpose of the bill of complaint which was filed in this case was to obtain;
a temporary restraining injunction prohibiting the defendants, the mayor and
city council of Baltimore, Dr. Huntington Williams, the commissioner of healthy
and Mr. Joseph S. Strohmeyer, water engineer of Baltimore City, from introduc-
ing fluorine into the water supply of Baltimore City until a hearing has been
had in this matter, and to permanently restrain the defendants from intro-
ducing fluorine into the water supply of Baltimore City. The bill of complaint
was filed by two complainants. One of the plaintiffs, Mr. McFarlane, not only
did not testify in the case, but he did not, as far as I know, make his appearance
in the courtroom. At least I have not seen him in the courtroom during the
several days that testimony has been taken, and no explanation has been given
for his absence.
In the bill of complaint the plaintiffs allege that fluorine is a toxic substance
and its effect on the health of the people of Baltimore City is likely to be dele-
terious, especially in the case of aged people and people having certain organic
weaknesses. It is also alleged that the addition of fluorine to the water supply
of Baltimore City is a calculated risk, and that there are many important aspects
of such an adventure that have not been fully explored scientifically.
The preponderance of the evidence shows that fluorine ingested into the water
supply of Baltimore City in t'.ie proportion or amount that is contemplated to
be used is not toxic. The evidence also is that its effect on the health of the
people of Baltimore City will not be deleterious even in the case of aged people
or people having certain organic weaknesses. The evidence also shows that this
pro.1ect is not a calculated risk, and that it would be safe at this time as a result
of the experiments that have already been made that the fluoridation of the
water be immediately undertaken.
Dr. Williams testified that there is no substantial disagreement among com-
petent scientists that the proposed fluoridation of Baltimore's water supply will
have any effect at all of a deleterious nature on aging people or on people of
any age group. It also appears from the report on Fluoridation of Water Sup-
plies of the National Research Council, published November 29, 1951, and which
report was offered in evidence, that :
"In the accumulated experience there is no evidence that the prolonged in-
gestion of drinking water with a mean concentration of fluorides below the level
causing mottled enamel would have adverse physiological effects."
FLUORIDATION OF WATER 247
The chairman of the National Research Council Committee on this matter ^vas
Dr. Kennedy F. Maxcy, professor of epidemiology, Dr. A. McGehee Harvey, pro-
fessor of medicine, and Dr. Abel Wolman, professor of sanitary engineering,
were members of the committee. These gentlemen are at Johns Hopkins Uni-
versity. Among the other members were representatives of the United States
Public Health Service, the University of Cincinnati College of Medicine and
the University of Minnesota School of Pul)lic Health.
Dr. Williams further testified to the effect that any claims made that fluoride
in the minute amounts to be added to the city's water supply, namely, one part per
million, would be harmful to persons suffering from rheumatism and arthritis
nre not correct and cannot be scientifically confirmed. He further testified that
uo bodily defects attributable to waterborne fluorine below the eight parts per
million level have ever been corroborated and that careful physical and dental
examination of Newburgh (Newburgh, N. Y., study) children exposed to fluori-
dation of their water supply for G years disclosed no ill effects in the eyes, ears,
bones, or teeth or vital organs, and further, that the Baltimore City Health De-
partment has been studying the matter of the fluoridation of the t-ity water supply
since the first request to do so was received from Mayor D'Alesandro during the
jnonth of August lU.jO.
In November 19.')0, the Baltimore City Dental Society approved the fluorida-
tion of the Baltimore City water supply. In November IQ^, the Medical
and Chirurgical Faculty of Maryland, which is the State medical society, placed
itself on record as approving the fluoridation of the Baltimore City water supply.
In 10.51 the Maryland State Board of Health after due consideration approved
the addition of fluoride to the city water supply of Hagerstown, and on De-
cember 20. 1951, approved the same procedure for Baltimore City.
Dr. Maurice E. Pincoft's, professor of medicine at the University of Mary-
land, who serves with the Commissioner of Health of Baltimore City, and who
is a member of the Maryland State Board of Health, personally approved the
fluoridation of the Baltimore City water supply, and he testified it would be
a safe and important procedure for the partial preventicm of dental decay in
children.
There is testimony that in many Maryland connnunities there is naturally
more than one part per million of fluoride in the normal drinking water, and
that there is no evidence that there has been any harmful eff'ect from long con-
tinued drinking of these natural waters in those various communities.
The purpose of adding fluoride to the city water supply, it has been testified,
is to prevent needless tooth decay and suffering for thousands of Baltimore chil-
dren in the future and for better adult health as the years go by. From the
l>est available evidence the Commissioner of Health of Baltimore City testified
that well over 95 percent of the soundest scientific thought in the United
States is in favor of the view that there is no danger in adjusting a city water
supply to one part per million of fluoride, and that further if this procedure is
adopted that roughly two-thirds of all the dental decay in children as the years
go by will be eliminated.
The testimony of Dr. Williams has l)een supported l3y many scientists, in-
cluding medical and dental authorities not only from this State but from other
States in the country, who have come here to testify as to their knowledge of the
situatitm, and they all join in the approval of the plan. Dr. Williams, our own
commissioner of health, is a very competent, capable, and honest puiflic official.
He has recommended this fluoridation of the water to the city council and the
mayor. They have accepted this recommendation, and I see no reason why
the court should not also do so. We must rely on scientists and doctors and
dentists in technical affairs of this kind, and when we have an honest opinion
given after a careful study I think it is entitled to great weight and should be
adopted, so I find from the evidence that there is nothing in this proposed pro-
gram that would be deleterious to the health of the people of Baltimore City, and
I do not find from the evidence that the addition of fluorine to the water supply
is a calculated risk of any kind.
The objection is also made by Harry C. Hoffman, one of the complainants,
that the introduction of fluorine into the water supply would be an infringement
of his constitutional rights, he being a Christian Scientist, alleging that the intro-
duction of fluorine into the water supply of Baltimore city will compel him to
violate one of the basic principles of his religion. A letter was introduced in
evidence from the committee on publication of the Christian Science publications
for Maryland in which it is stated that :
248 FLUORIDATION OF WATER
"Adherents of Christian Science regard medication and medical examination
of all sorts as methods of indoctrination which operate to teach them to look ta
the physical body for health, whereas Christian Science teaches that health
comes from God and true prayer makes that fact evident."
The argument is made that to require him to use city water after it has been
ingested with fluoride, which it is claimed is a drug, would require him to submit
to something which is against the tenets of his religion. However, the question
as to whether this is medication is a debatable one, because in the opinion of
Dr. Pincofts he would not consider this as being medication, so that irrespective
of the merits of the contention of Mr. Hoffman on broad constitutional lines, as
a question of fact it is debatable as to whether or not the use by him of this water
after fluoride has been put into it would be a violation by him of the tenets of
his religion. It has been shown in the evidence that in other large cities the
water has been treated exactly the same as it is proposed by the water engineer
and the commissioner of health to treat the water in the city of Baltimore.
In the case of Aryan v. Butler, Mayor of San Diego, California, et al., in the
Superior Court for San Diego County, Calif., (No. 169974, decided April 3,
1952), the identical question involved here was presented to that court for de-
cision by a member of the Christian Science faith who opposed the fluoridation
of the water in San Diego. The court, in a memorandum opinion on motion for
nonsuit, stated :
"Religious freedom embraces two concepts, freedom of belief and freedom
to act. The first is absolute, but in the nature of things the second cannot be,
in that all acts or conduct of our citizens must conform to all reasonable regula-
tions adopted by the respective governmental agencies acting within the scope
of their authority."
And in that connection, the court quoted from an opinion of the State Supreme
Court of California. Rescue Army v. Municipal Court (28 Cal. 2d) 460, 470),
as follows :
"There can be no question, therefore, that a person is free to hold whatever
belief his conscience dictates, but when he translates his belief into action he may
be required to conform to reasonable regulations which are applicable to all
persons and are designed to accomplish a permissible objective."
It was held in the Aryan v. Butler case that no constitutional rights of any of
the citizens of San Diego would be invaded or violated by the adoption of the
proposed program.
In a case decided by the New York Court of Appeals (176 N. Y. 201) , which was
a prosecution for failure to provide medical attention for the accused's female
minor child, the defense was made that it was contrary to the tenets of the
religion of the accused to provide or call on medical services for relief from
physical disease, but in that case the court of appeals held :
"We are aware that there are people who believe that the divine power may
be invoked to heal the sick, and that faith is all that is required. There are
others who believe that the Creator has supplied the earth, nature's storehouse,
with everything that man may want for his support and maintenance, including
the restoration and preservation of his health, and that he is left to work out his
own salvation under fixed natural laws. There are still others who believe that
Christianity and science go hand in hand, both proceeding from the Creator ;
that science is but the agent of the Almighty through which he accomplishes
results, and that both science and divine power may be invoked together to
restore diseased and suffering humanity. But, sitting as a court of law for the
purpose of construing and determining the meaning of statutes, we have nothing
to do with these variances in religious beliefs and have no power to determine
which is correct. We place no limitations upon the power of the mind over the
body, the power of faith to dispel disease, or the power of the Supreme Being
to heal the sick. We merely declare the law as given us by the legislature. We
have considered the legal proposition raised by the record, and we have found no
error on the part of the trial court that called for a reversal."
In the court below in that case the accused was found guilty. The appellate
division of the supreme court, reversed, and on appeal to the court of apijeals
the appellate division was reversed and the conviction was sustained.
We also find the following language in an opinion by Mr. Justice Field in the
Supreme Court of the United States in the case of Davis v. Beason (133 U. S. 333) :
"The term 'religion' has reference to one's views of his relations to his Creator,
and to the obligations they impose of reverence for his being and character, and
of obedience to his will. It is often confounded with the cultus or form of worship
FLUORIDATION OF WATER 249
of a particular sect, but is distinguishable from the latter. The first amendment
to the Constitution, in declaring that Congress shall make no law respecting the
establishment of religion, or forbidding the free exercise thereof, was intended
to allow everyone under the jurisdiction of the United States to entertain such
notions respecting his relations to his Maker and the duties they impose as may
be approved by his judgment and conscience, and to exhibit his sentiments in
such form of worship as he may think proper, not injurious to the equal rights
of others, and to prohibit legislation for the support of any religious tenets, or
the modes of worship of any sect. * * * There have been sects which denied as
a part of their religious tenets that there should be any marriage tie, and advo-
cated promiscuous intercourse of the sexes as prompted by the passions of its
members. And history discloses the fact that the necessity of human sacrifices
on special occasions has been a tenet of many sects. Should a sect of either of
these kinds ever find its way into this country, swift punishment would follow
the carrying into effect of its doctrines, and no heed would be given to the pre-
tense that, as religious beliefs, their supporters could be protected in their
exercise by the Constitution of the United States."
There is no question that under the Constitution of both the United States
and the State of Maryland a person has a right to believe in any particular
religion or faith that he cares to, but he does not have the absolute freedom to
act in accordance with the tenets of any of those religions, but in his action he
is bound to follow the laws duly enacted for the preservation of the health of
citizens generally. He cannot object on religious grounds to laws enacted either
by National, State, or city authorities. I find in this case that from the evidence
none of the constitutional rights of the plaintiff, Hoffman, to freedom of religious
belief would be invaded or violated by the adoption of the proposed program.
I might say also that we have several cases in Maryland, particularly the case
of Jiidcfind V. State (78 Md. 510), in which a man was indicted for violating the
law prohibiting work on Sunday. The objection was made that members of a
certain denomination do not observe Sunday as their Sabbath ; that they observe
as their Sabbath another day during the week ; and they contended if the law
was upheld, it would promote the Christian religion to the detriment of their
religion, which allowed its members to work on Sunday. The court of appeals
affirmed the conviction in that case and held that the believers in every religion
were required to submit to the laws duly passed by the proper authorities. See
also Hiller v. State (124 Md. 38-5), in which a law prohibiting playing baseball
on Sunday was attacked on constitutional groimds.
The question has arisen as to the right of the city to adopt this program of
fluoridation. It has been suggested that the city has the right to do this under
subsection 11 of section 6 of the city charter, which authorizes the mayor and
the City Council of Baltimore to provide for the preservation of the health of
all persons within the city, to prevent the introduction of contagious diseases
within the city and within 3 miles of the same upon land and within 15 miles
thereof upon the navigable waters leading thereto, and to prevent and remove
nuisances. And also under subsection 24, section 6, of the city charter, which
is a delegation to the city of the police power in the city to the same etxent as
the States has or could exercise said power within said limits, but it seems to me
that subsection 37, section 6, of the city charter would be more applicable here.
Under subsection 37 of section 6, the mayor and City Council of Baltimore is
given the right and power to establish, maintain, regulate, and control a system
of water supply, and to make charges for the consumption or use of said water.
I am of the opinion that the power to promulgate and go through with this
program would be sanctioned under that provision and subsection 11 of section 6,
relating to health and nuisances.
I find nothing in the charter or in the ordinances that would authorize the
water engineer or the commissioner of health to go through with a plan of this
kind on their own initiative. It has been suggested that the water engineer
would have the right to do that, but the power given him under the city charter
and also under the code are limited and restricted. And it has been suggested
that the water engineer would have authority under section 642 of the city
charter, which provides for water supply improvement. Gunpowder River, but
that section is a grant of power to the mayor and City Council of Baltimore, and
is not a grant of power to any particuular official of the city.
Section 81 of the city charter creates the department of health, the head of
which shall be the commissioner of health, who shall be appointed by the Mayor,
and provides that: "He shall cause the ordinances for the preservation of the
250 FLUORIDATION OF WATER
health of the inhabitants of Baltimore City to be faithfully executed and strictly
observed."
It goes on then to provide for his salary and other matters that have nothing
to do with his powers. Under that section of the charter he is charged with the
duty of enforcing the ordinances. In the city code, article 12, section 1 :
"The commissioner of health is required from time to time to make observa-
tions of the several parts of the city and its environs which may be deemed the
cause of disease, and in all cases where he may discover the existence of any
agent the presence of which will prove dangerous to the health of the inhabi-
tants, he shall cause any ordinances in existence for its correction to be enforced,
or if there be no ordinance competent to the correction of the evil he shall
make a full report of all of the attending circumstances to the mayor, accom-
panied by his opinion of the necessity of extraordinary or particular action."
Other provisions of that section indicate he acts in an advisory capacity, and
that he is the watchdog for the city as to any matters that may be prevalent here
that would cause the spread of disease, and it is his duty to take all action within
his power to prevent disease, and in the event he has not the authority to take
appropriate action then it is his duty to report it to the mayor so that an ordi-
nance or resolution may be passed giving him the specific authority to act in any
instances in which it should be necessary for him to do so. Of course there are
many other instances where there are direct ordinances authorizing him to take
action in certain cases.
It appears from the evidence that this authority of the water engineer and
the commissioner of health to act in this case is derived from certain resolutions
passed by the City Council of Baltimore, and the question then arises as to
whether the City Council of Baltimore has the authority to act by way of resolu-
tion rather than by ordinance. There are several provisions in the Charter re-
garding the legislative duties and powers of the mayor and City Council of Balti-
more under the charter.
Section 11, page 45, provides : "All ordinances or resolutions duly passed by the
city council after being properly certified by the president of the city council as
having been so passed, shall be delivered by the clerk to the mayor for his ap-
proval, and there shall be noted on said ordinance or resolution the date of said
delivery."
Then it goes on to provide what should be done in the event that the mayor
vetoes certain ordinances or resolutions, that they should be returned to the
city council for further action.
Section 26 provides that "ordinances and resolutions of the city may be read
in evidence from the printed volumes thereof published by its authority."
And section 28 of the city charter states : "Every legislative act of the city
shall be by ordinance or resolution."
So I would take it from that provision in the city charter that a resolution not
only can be but must be considered a legislative act of the city council, entitled
to the same weight and respect as an ordinance.
In 62 C. J. S., page 786, Municipal Corporations, No. 411, it is stated that the
terms "resolution" and "ordinance" have been used interchangeably, and that
the term "resolution" has been held to be the equivalent of the term "ordinance'
although a resolution generally is less solemn and formal than an ordinance, and
further that a resolution passed with all formalities required for passing ordi-
nances may operate as an ordinance regardless of the name by which it is called.
In Pennsylvania, in the case of Kcpncr v. Coimnomrealih (40 Pa. 124), the
court held that a resolution is only a less solemn or less usual form of an ordi-
nance, but that it is an ordinance still if it is in any way intended to regulate any
of the affairs of a municipality.
The first resolution that was passed by the city council is Resolution No. 2469.
That was introduced on November 13, 1950. and provides :
"Whereas the American Dental Association has approved the fluoridation of
the water supply as a preventive of dental decay, particularly in children, there-
fore, be it resolved by the City Council of Baltimore that the Water Bureau and
the Health Department of Baltimore City be and they are hereby requested to
study the desirability of using fluoride chemicals in the water supply for the pur-
pose of preventing the decay of children's teeth, and be it further resolved that if
this study indicates that it is desirable to use fluoride chemicals steps be taken
to do this at the earliest practicable date."
The next resolution that was introduced was Resolution No. 506 (introduced
February 25, 1952), and it provides:
FLUORIDATION OF WATER 251
"Whereas there is disagreement among scientists as to the effect of water
fluoridation on aging people, and whereas claims are made that fluoride is
harmful to persons suffering from rheumatism and arthritis: Now, therefore,
be it
Resolved, hy the City Council of Baltimore, That the health committee request
the commissioner of health and the water engineer to give to it whatever infor-
mation is available on this treatment by fluoridation of city water supplies."
A further resolution, No. 533, was introduced on March 10, 1952, which pro-
vided that :
"Wliereas there seems to be considerable uncertainty as to the wisdom of
placing fluoride in the water supply, and
Whereas it seems desirable that further study should be given to this important
subject in order to determine whether such chemical will be harmful to certain
adults, and
Whereas while such fluoridation of water may be beneficial to young children,
if the result is that adults are seriously harmed, and
Whereas a slight further delay until additional information may be obtained
may not prove to be harmful : Now, therefore, be it
Resolved by the City Council of Baltimore, That the commissioner of health and
the water engineer of Baltimore City be and they are hereby requested to delay
the fluoridation of the city's water supply until additional information has been
acquired in order to determine whether it is a wise step to take under all of
the circumstances."
I understand from the testimony there was a public hearing held on this last
ordinance, No. 533, in which persons testified in favor of the resolution, and
of course the commissioner of health and others testified against the resolution,
and the resolution was defeated, the evidence shows, by a vote of 17 to 4, and
after this resolution was defeated Dr. Williams testified that he considered it
then to be an ultimatum to him to proceed with the fluoridation of the water
supply.
I might state that in accordance with resolution 506 the commissioner of health
did make a study of the situation and favorably reported on this program to the '
mayor and City Council of Baltimore, as I have previously referred to in com-
menting on Dr. Williams' testimony in this case. So that because of the fact
that this study indicated it would be desirable to use fluoride chemicals in
accordance with resolution 2469, it seems to the court that there was ample
authority to the commissioner of health and the water engineer to proceed with
the program at the earliest practicable date, as provided in resolution 2469. '
I find from the evidence and from a consideration of the city charter that
this resolution which was duly passed by the council and approved by the
mayor constitutes a legislative act of the city council, and the commissioner of
health and the water engineer were in duty bound to comply with the pro-
visions of the resolution. As a matter of fact, if they had not complied they
would be subject to official censure for not acting in accordance with a resolu-
tion duly passed by the city council which declared it was the legislative intent
of the city council, approved by the mayor, that this program of ingesting fluoride
in the limited degree that it is proposed to do in the city water supply would
be advantageous to the citizens of Baltimore City.
The argument is made that because the city water supply is supplied to
certain localities in 3 counties bordering the city, one, Baltimore County, and
the others, Anne Arundel County and Howard County, that it would be a
deprivation of constitutional rights of the inhabitants of those 3 counties who
are supplied with city water to be required to comply with legislation which was
passed locally in Baltimore City. However, the plan has been approved by
the State department of health, and there are no individuals in any of the locali-
ties in the counties involved in this program who have made any complaint
at all, so that in the absence of a complaint from members of those localities
I am of the opinion that argument is not sufficient in this case to prevent the
city from proceeding with this program.
For the reasons stated above I will sign a decree dismissing the bill of com-
plaint, the plaintiffs to pay the costs.
48391-
252 FLUORIDATION OF WATER
Monday, May 31, 1954
SUPREME COURT OF LOUISIANA
No. 41717
Marke E. Chapman et al. v. City of Shreveport
Appeal from the First Judicial District Court, Parish of Caddo ; the Honorable
James U. Galloway, judge
Hawthorne, J.
This is an appeal by the city of Shreveport from a judgment enjoining it
from fluoridating the municipal water supply. The city of Shreveport owns and
operates its own municapal waterworks plant and other facilities for the sale
and distribution of water for consumption and other uses of the inhabitants of
that city. On October 16, 1953, the Shreveport City Council adopted a resolu-
tion authorizing the commissioner of public utilities to proceed with the adver-
tising and calling for bids for the necessary equipment to fluoridate the city
water supply in accordance with the best plans now available, and to receive
these bids on or before October 27. The initial amount which the city pro-
poses to spend in order to fluoridate the water supply is shown by the record
to be in excess of $10,000 and the annual operating expense approximately $21,000.
The plaintiffs, as residents, citizens, taxpayers, and purchasers of water from
the city, instituted this suit seeking a preliminary writ of injunction to prevent
the proposed fluoridation of the public water supply and the expenditure of these
public funds for such purpose. After trial in the lower court a preliminary
injunction issued enjoining, I'estraining, and prohibiting the city of Shreveport
from proceeding further to fluoridate the water supply of that city. From that
judgment the city was granted a devolutive appeal to this court.
As we appreciate and understand the trial judge's written opinion, he granted
. a preliminary injunction in the instant case because in his opinion the charter
of the city of Shreveport delegated no authority, express or implied, to the city
to fluoridate its water supply, and the city did not have this power or right under
its police power in the domain of public liealth. In the course of his reasons
for judgment he recognized the well-settled principle of law that a municipal
authority may take any action it may determine to be necessary and expedient
under its police power in the domain of pul)lic health, provided the purpose and
object of such action bears a reasonable relation to the public health and pro-
vided the means employed is not arl)itrary, unreasonable, oppressive, or violative
of the constitutional guaranties of the citizens. He concluded, however, that
under the facts of the instant case the fluoridation of the city water supply
bears no reasonable relation to the public health or that it is not a matter of
public health but is strictly within the realm of private dental health and hygiene,
in which each person should be free to choose his course for himself and those
for whom he is responsible in the family relationship.
For the primary purpose of reducing tf)Oih decny in children 12 years of age
and under, the city of Shreveport proposes to add to the water furnished by it
for the use and consumption of its citizens sodium fluoride in the proportion of
1 part per million. In furtherance of this purpose the resolution authorizing
the calling for bids for the necessary equipment for fluoridation was adopted by
the city council at the request of the council on dental health of the Fourth Dis-
trict Dental As.s^ociation, the Shreveport Medical Society, and the City Board
of Health of Shreveport, all of which advocated and approved the fluoridation
of the city's water supply.
The relationship between the fluoride content of water supplies and dental
caries has been tlie subject for some years of extensive scientific study, research,
and experiments, and as a result of this research the court in the instant case
has the benefit of facts ascertained, studies made, and opinions formed by many
leading and prominent American dentists, physicians, surgeons, scientists, health,
and dental associations and organizations whose statements have been filed in
evidence, on the advisability of the fluoridation of water for human consumption.
In sum. these statements disclose the following pertinent facts :
Dental caries, or tooth decav. is a pandemic disease, affecting most of our
population, both adults and children. Flourides in varying proportions from
less than 1 to 14 parts per million exist naturally in the water supplies of many
regions of this country, and it has been demonstrated by studies made in many
FLUORIDATION OF WATER 253
sections throughout the United States that in communities where the water
supply contains no fluoride tooth decay among children is approximately 3 times
greater than it is among children living in communities where the water supply
contains 1 part of fluoride per million parts of water or more. In these studies
other factors of diet and other mineral components of water were considered,
but it was found that only the fluoride content of the water consumed bore direct
relationship to consistent protection from dental caries. This preventive effort
of fluorides on tooth decay was found to be most efl3cient during the i)eriod
when the dentine and enamel of the permanent dentition are being formed,
which is the period from birth to about the 12th year, but it was shown that
the protection afforded against dental caries in this formative period continues
well into adult life, even into the middle thirties and forties. Studies were
made of the effect on tooth decay when fluorides were artificially added to-
municipal water supplies, and it was found that the fluorides artificially added*
had the same preventive ett'ect on caries as did the fluorides naturally existing,
in water.
By November 6, 1953, more than 840 communities, with a total population of
15,578,300, were using water supplies which had been artificially fluoridated
in concentrations from 0.7 to 1.5 parts per million. By 1951, after 5 or 6 years
of the fluoridation of the water supplies in certain cities, studies and exami-
nations were made of the teeth of school children in these cities (and also, for
comparison, of those of the children in cities where the water supply con-
tained no fluorides), and the flnding reported was that there has been a reduc-
tion of from 50 percent to 65 percent of decay in permanent teeth in children^,
in the cities where fluorides had been added artiflcially to the water. As a
result of these studies and experiments the United States Public Health Service,,
the National Institutes of Health, the American Dental Associaion, and num-
erous other national organizations recommended the fluoridation of municipal
water supplies as a desirable and effective health measure.
The city of Shreveport proposes to use the recommended concentration of
one part per million, and this concentration has not been reported to produce-
any adverse physiological effect. Vital statistics and reports of physicians from
conjmunities where water containing one part per million or over is consumed
have shown uniformly no undesirable effects on birth or death rates or oa
invalids, elderly, or sick individuals, or any other persons.
The addition of fluorides to the water supply does not affect the color, odor,
or taste of the water. The same kind of procedure which has long been used'
to feed chlorine and other chemicals into the water supply is used to introduce
fluorides into the water, and there is no question that fluorides can thus be
added to the water without danger of physical overfeeding or any mechanical
breakdown which would produce a toxic effect.
The charter of the city of Shreveport, which was written under the authority
of a 1948 amendment to article 14, section 37, of the Constitution and approved'
by a vote of the citizens of that community in 1950, confers upon that city the-
power to adopt such measures as are necessary in the opinion of the council to
promote the general welfare of the inhabitants of that city in section 2.01 of the
charter [sic] :
"General Powers. — The city of Shreveport shall have and may exercise all
the powers, rights, and privileges and immunities which are now or may here-
after be or could be conferred upon cities of its population class by the constitu-
tion and general laws of the State ; all powers, rights, privileges, and immunities
heretofore conferred on said city by any special act and not inconsistent with-
this plan of government ; and all other powers pertinent to the government of the
city tlie exercise of which is not expressly prohibited by the constitution of the
St.-ite and which, in the opinion of the council, are necessary or desirable to
proiitotc the general tcelfare of the city and the safety, health, peace, good order,
comfort, convenience, and morals of its inhabitants, as fully and completely as
thouii'h such powers were specifically enumerated in this plan of government, and
no enumeration or particular powers in this plan of government shall be taken
to he exclusive but .shall be held to be in addition to this general grant of power."
[Italics ours.]
Accordingly, if fluoridation of the water supply bears any reasonable relation.
to the public health, it can be undertaken by the city under the express provi-
sions of this section of its charter. Moreover, it is well settled that courts will
not interfere with the legislative authority in the exercise of is police power
unless it is plain and palpable that .such action has no real or substantive relation.
254 FLUORIDATION OF WATER
to the public health or safety or general welfare (City of Shreveport v. Conrad,
212 La. 737, 33 So. 2d 503 ; City of Shreveport v. Bayse et al., 166 La. 689, 117
So. 775). There also exists a presumption that an ordinance adopted under the
police power of the State is valid, and the burden of proving the contrary is on
him who asserts the invalidity or nullity (City of Neiv Orleans v. Beck, 139 La.
595, 71 So. 883 ; Ward et al. v. Leclie et al., 189 La. 113, 179 So. 52 ; State v. Saia,
212 La. 868, 33 So. 2d 665; State v. Rones, 223 La. 839, 67 So. 2d 99).
Although the immediate purpose of the proposed fluoridation is to retard and
decrease the disease of dental caries in young children, the protection thus given
will continue well into adult life. Not only will the proposed fluoridation retard
and reduce this disease in the generation of children presently in Shreveport,
but its effect will continue into their adult life, and consequently the proposed
measure will ultimately be beneficial to all the residents of the city.
The health of the children of a community is of vital interest and of great
importance to all the inhabitants of the community. Their health and physical
well being is of great concern to all the people, and any legislation to retard
or reduce disease in their midst cannot and should not be opposed on the ground
that it has no reasonable relation to the general health and welfare. Children
of today are adult citizens of tomorrow, upon whose shoulders will fall the
responsibilities and duties of maintaining our Government and society. Any
legislation, therefore, which will better equip them, by retarding or reducing
the prevalence of disease, is of great importance and beneficial to all citizens.
In our opinion, the legislation does bear a reasonable relation to public health.
The appellees insist, and the district judge concluded, that fluoridation of
the water to prevent tooth decay is not a matter of public health, but a matter
of private health and hygiene. The evidence in this record refutes overwhelm-
ingly this conclusion. Dental caries is one of the most serious health problems
in the city of Shreveport, and in the Nation as well. The fact that it is not a
communicable disease and one that can cause an epidemic does not detract
from its seriousness as affecting the health and well being of the community.
The plan for fluoridation, therefore, bears a reasonable relation to the general
welfare and the general health of the community, and is a valid exercise of
the power conferred by section 2.01 of the charter if it is not arbitrary or
unreasonable.
The appellees contend that fluoridation of the water supply is arbitrary and
unreasonable because it may cause serious ill effects to the adult, aged, and
ill ; that it is arbitrary to fluoridate the water until clinical tests have proved
that these serious effects will not result. The appellees have failed completely
to prove that fluoridation would be harmful to the aged and ill.
There is expert opinion of respectable medical authority that fluorides added
to water will have no more harmful effect than fluorides naturally appearing in
water, and that in those places where fluorides naturally appear no ill effects
have been experienced by the aged or ill of the population. In those places
where tests have been conducted no ill effects have been shown. It cannot be
said, then, that the city of Shreveport is acting arbitrarily from this point of
view.
Appellees contend that it is arbitrary and unreasonable to compel a pei'son
to submit to the taking of preventive medicine except for the purpose of con-
trolling the spread of contagious or infectious diseases. Their argument is not
entirely appropriate to the instant case. In the first plac-e, there is no direct
compulsion on anyone to drink the water. The compulsion at most is an indirect
one, but it cannot be questioned, of course, that the fluoridation is undertaken
with the view that the citizens or a large majority of them will receive its
benefits by drinking the public water. The witnesses from the dental pro-
fession considered that the addition of fluoride to the water was not medicating
it in the generally accepted sense, but was adding to it one of the mineral
properties found naturally in water in some sections of the country.
Appellees next argue that it is unreasonable to fluoridate the water when
it will reduce the incidence of disease only among a limited class. A health
measure is not necessarily arbitrary because it aifects primarily one class. It
may, even so, be in the interest of the public generally. Ultimately, of course,
the fluoridation will benefit the whole population because the retarding of decay
extends into adult life of the child who has had the benefit of water containing
fluorides. It has long been recognized that a police measure is not objectionable
because it does not extend to all classes. In Zueht v. King et al. (260 U. S.
174, 43 S. Ct. 24, 67 L. Ed. 194) , it was said :
FLUORIDATION OF WATER 255
"* * * A long line of decisions by this court * * * (has) settled that in the
exercise of the police power reasonable classification may be freely applied and
that regulation is not violative of the equal protection clause merely because it
is not all-embracing. * * *" (See also West Coast Hotel Co. v. Parrish et al.,
300 U. S. 379, 57 S. Ct. 578, 81 L. Ed. 703 ; Stui-gcs d Barr Manufacturing Co. v.
Bcauchamp, 231 U. S. 320, 34 S. Ct. 60, 58 L. Ed. 245.)
There is no merit in appellees' argument that, if the city charter grants to the
city council of Shreveport authority to tluoridate its water supply, such action
to that extent is a violation of the 14th amendment of the United States Consti-
tution. The 14th amendment does not deprive a State or its subdivisions of
the right to preserve order or to protect the health of the people under its police
power, and in the exercise of its power the legislative branch may interfere with
and impair the individual liberty of the citizens in a manner and to an extent
reasonably necessary for the public interest, and the courts will not interfere
except where the measures invade fundamental rights or are arbitrary, oppres-
sive, or unreasonable. This is not a proper case for judicial interference. (See
Cooley on Constitutional Law (4th ed.), p. 289; 2 Cooley's Constitutional Limita-
tions (Sth ed.), pp. 1223 et seq. ; Jacobson v. Massachusetts, 197 U. S. H, 25 S. Ct.
358, 49 L. Ed. 643 ; State v. McCormick, 142 La. 580, 77 So. 288.)
For the reasons assigned, the judgment of the district court is reversed and
set aside, and plaintiff's suit is dismissed at their costs.
Mr. Gar\'ey. I would like now to present to you, Mr. Cliairman,
Dr. E. Harold Gale.
STATEMENT OF DR. E. HAROLD GALE, ALBANY, N. Y., CHAIRMAN,
COUNCIL ON LEGISLATION OF THE AMERICAN DENTAL ASSO-
CIATION
The CHAiRMAisr. You may proceed, Dr. Gale.
Dr. Gale. Thank you.
I am E. Harold Gale, a practicing dentist of Albany, N. Y., and
chairman of the Council on Legislation of the American Dental Asso-
ciation. I am here today to present the views of the association with
respect to H. R, 2341, entitled : "A bill to protect the public health
from the clangers of fluoridation of water." With me to present addi-
tional scientific testimony are Drs. H. Trendley Dean and J. Roy Doty,
of Chicago, 111. Mr. Dean is secretary of the association's council
on dental research; Dr. Doty is secretary of its council on dental
therapeutics. Also present is Mr. Francis J. Garvey, of Chicago, 111.,
secretary of the council on legislation.
The American Dental Association is the official spokesman for more
than 80 percent of the practicing dentists of this country. It speaks
for the members of a profession which exists to study the teeth and
supporting structures, tlie diseases and disabilities which affect them,
and the methods by which such diseases and disabilities may be pre-
vented, treated, and cured. The most prevalent of the dental dis-
eases is known as dental caries, commonly referred to by laymen as
tooth decay. This is likewise the most prevalent of all human dis-
eases. It affects approximately 95 percent of the population of the
United States. Children as young as 2 years are afflicted with it and,
if untreated, the disease may cause pain and suffering in all age groups
so long as the teeth remain in the mouth. It is a disease from which
the individual neither dies nor recovers. Once a carious lesion occurs,
the affected hard tissue can never regenerate itself. The lesion can
only get worse until it is treated by the dentist. Last year the Amer-
ican people spent more than $li/^ billion for dental care, much of
which cost may be directly attributed to the treatment of dental decay
256 FLUORIDATION OF WATER
or to the replacement of teeth lost on account of decay. In addition,
the Federal Government spent more than $100 million for dental
service for members of the Armed Forces, for veterans, and for bene-
ficiaries of the United States Public Health Service.
And may I interpolate right here that I am sure the American
Dental Association can be safe in feeling that there is no hope for its
members in a monetary gain when they are advocating a method which
they feel has proven to reduce the incidence of decay which would
have an adverse effect on their income. I think that answers the
whole question of motivation as far as the dental association is
concerned.
Manifestly, it is important healthwise and from an economic stand-
point to encourage the development and use of effective preventive
measures which will give the American people some relief from the
2:)ain and expense that this disease entails.
The most successful preventive procedure yet devised for the reduc-
tion of the incidence of tooth decay is the fluoridation of communal
water supplies.
Community water fluoridation is merely the introduction into the
water system of a comminiity of a sufficient amount of fluoride-bearing
material to produce in the water a fluoride ion content of approxi-
mately 1 part of fluoride ion to 1 million parts of water. Tlie fluoride
ion can be obtained from any number of chemicals. As you will hear
from the waterworks engineers who will testify here, the process of
adjusting the fluoride ion content of a public water supply is simple
and sage. It is likewise relatively inexpensive both to install and to
keep in operation. It lias been estimated that the total cost of pro-
viding fluoridated water is only about 10 cents per year per person,
about the. cost of an ice cream cone. Others will tell you in detail of
the beneficial results to be obtained in terms of decay reduction. Let
me say only that the evidence of controlled studies reveals a reduction
60 to 65 percent of the amount of tootli decay that might otherwise be
exoected to occur were the water supplies lacking fluorine.
Extravagant statements have been made by the opponents of fluori-
dation. Some have said that it will cause cancer. In a letter to Dr.
Aubrey Cox, of Wichita Falls, Tex., dated March 25, 1954, which J
have attached hereto as appendix A so that it may be made part of
the record, Dr. Charles S. Cameron, president of the American Cancer
Society, said :
The American Cancer Society does not consider fluorine or the common fluorine
salts to be carcinogenic. Its position, therefore, with respect to water fluorida-
tion for the purpose of dental caries prophylaxis, is that such treatment of public
water supplies is without danger so far as cancer causation is concerned.
'Some have said that this process involves the introduction of a
poison into the water supply. As Dr. Doty and others will tell you,
the recommended amount of 1 \)nvt of fluoride ion per 1 million parts
of water is not toxic. AVe employ many things in our daily lives which
if used in excessive quantities Avould be poisonous but which in the
proper amounts have a beneficial effect, for exam]:)le, chlorine in water,
iodine in salt, vitamins in foods, enrichment additives in bread. Some
have said that community water fluoridation would have an adverse
effect upon the kidneys. This has been adequately refuted by eminent
scientists highly trained in this field of physiology.
FLUORIDATION OF WATER 257
Other iinfoiinded claims as to the daiiirPi's of fluoridation have failed
to find the su])port of scientific evidence.
Tlie title of H. R. 2841 makes an unwarranted assumption that the
public is in danger from water fluoridation. It then proceeds in the
text of the bill to assume that the Congress has powers of local regu-
lation never given to it by the Constitution. While Congress conceiv-
ably has the power to prohibit the fluoridation of water in Federal
territory and the power to prohibit Federal installations from receiv-
ing fluoridated water, no known principle of law has as yet conferred
upon it the power to tell States and their local political subdivisions
how to exercise the police power which is inherent in such States and
municipalities. H. R. 2341 is, our attorneys advise us, clearly uncon-
stitutional in its attempt to prohibit States and their political sub-
divisions from treating with fluorides municipal water supplies, or
from making available to any person or institution, not an instru-
mentality of the Federal Government, water which has been fluori-
dated, i am sure that your committee is aware of this.
Prior to 1950 responsible agencies of the American Dental Asso-
ciation for many years watched the growth and development of the
literature relating to fluoridation. In 1950, after years of careful and
considered scientific evaluation, these agencies recommended to the
house of delegates that the American Dental Association officially
endorse the fluoridation of water supplies. The resolution adopted
by the house of delegates is unequivocal and is attached to this state-
ment for the record as appendix B. In addition to the American
Dental Association, the dental societies of all 48 States and the
District of Columbia, the American Medical Association, the United
States Public Health Service, the American Academy of Pediatrics,
the Association of State and Territorial Health Officers, the Ameri-
can Public Health Association, the American Public Welfare Asso-
ciation, the Commission on Chronic Illness, the National Research
Council, the xVmerican Hospital Association, the American Nurses
Association, the Inter- Association Committee on Health, the Ameri-
can Waterworks Association, the State and Territorial Dental Direc-
tors, the American Society of Dentistry for Children, the American
College of Dentists, the dental section of the American Association
for the Advancement of Science, and various State and county
medical societies have approved the procedure. In short, every re-
sponsible national health agency in the country is in favor of the
process.
For the record, I would like to file, as appendix C, the statement
of the Interassociation Committee on Health, of which the American
Dental Association is a member. I would like also to request that
the chairman and other members of the committee file for the record
the statements of organizations not here today which have been mailed
to you on this subject. I hope also that you will include in the
record the general correspondence from dentists which I am sure
indicates in detail the nature of the problem of dental caries and
the value of community water fluoridation in all parts of the country
as seen through the eyes of the men responsible for the peo]:)le's dental
health, the practicing dentist o^ the communities in the United
States. May I also urge that you print the records of these hearings
so that those interested may have the benefits of the most up-to-date
facts about fluoridation ?
258 FLUORIDATION OF WATER
So that you may know the extent to which commuities throughout
the country have ah-eady accepted the fluoridation of public water
supplies I am attaching to my statement as appendix D a list of the
communities throughout the country whi^h, according to informa-
tion compiled by the association's council on dental health, are already
adjusting their water supplies so that they contain the optimal amount
of fluoride ion. You will notice that this list includes 944 communi-
ties in 43 States. Tlie list is current as of May 14, 1954, just 2
weeks ago.
In conclusion, I thank you on behalf of the association for the
opportunity to be present today to offer this testimony in support of
a program of inestimable value to the people of the United States.
The scientific aspects of the program will be discussed in detail by Drs.
Dean and Doty, who will follow me. I hope that you will see fit to
defeat this bill and by so doing to help in the improvement of the dental
health of American citizens.
(The appendixes referred to follow:)
Appendix A
March 25, 1954.
E, Aubrey Cox, M. D.,
Cotmnittee Chairman, City of Wichita Falls,
Wichita Falls, Tex.
De:ar Dr. Cox : The American Cancer Society does not consider fluorine or ttie
common fluorine salts to be carcinogenic. Its position, therefore, with respect
to water fluoridation for tlie purpose of dental caries prophylaxis, is that such
treatment of public water supplies is without danger so far as cancer causation is
concerned.
The evidence is as follows :
(1) Laboratory:
(a) Sodium fluoride does not accelerate the growth of established Walker rat
sarcoma in experimental animals.^ This is a standard test tumor widely used
in biological testing of growth stimulating or inhibiting compounds.
(&) Sodium fluoride appears to actually inhibit the development of spontane-
ous mammary carcinoma in mice."
(c) Extensive toxicity studies of fluorine and its compounds, under numerous
auspices, have failed to show that they have any cancer-causing or cancer-acceler-
ating effects.
id) The report of Alfred Taylor, Ph. D., of the biochemistry department of the
University of Texas Medical Branch, that fluorine-containing water accelerated,
the appearance of breast tumors in CsH mice (which are genetically highly sus-
ceptible to breast cancer) has been effectively countered by Dr. Edward Taylor,*
who quoted tlie findings of two scientists of the National Cancer Institute after
a review of Alfred Taylor's work : "Dr. Howard Andervont and I (Dr. H. T. Dean)
have carefully evaluated the data with respect to the alleged relation of fluoride
water to an accelerated rate in the development of mammary tumors and are
of the opinion that the evidence adduced does not warrant any modification in
the policy of recommending fluoridation of public water supplies for the partial
control of dental caries."
(2) Epidemiologic:
(a) Swanberg ^ has shown that the death rate from cancer in Grand Rapids,
Mich., was 206/2/100,000 in the year 1944 ; that fluoridation was begun in that
^ Effect of Fhioride on Tumor Growth : Finerty, J. C, and Grace, J. D., Texas Reports
on Biology and Medicine 10, 3 p. 501, 1952.
^ Tannenbaum, A., and Silverstone, H. Effect of Low Environmental Temperature
Dlnitrophenol, or Sodium Fluoride on the Formation of Tumors in Mice, Cancer Kesearch,
9, 7, p. 385, 1949.
* Taylor, E., Facts Relative to Tumors That Fluoridation is Harmful, Texas Dental
Journal, p. 381, September 1951.
* Swanberg, Harold, Fluoridation of Water and Its Relation to Cancer, Mississippi Valley
Medical Journal, 75 : 125-128, September 1953.
FLUORIDATION OF WATER 259
city in January 1945 ; and that the death rates per hundred thousand of population
for succeeding years were as follows :
1945 190. 5
194G 170. 4
1947 172. 3
li^S 163. 1
1949 187. 6
1950 189. 2
1951 183. 1
1952 185. 3
(6) A comprehensive study by the United States Public Health Service was
based on all cities in the United States having population of 10,000 and over
whose water* contained 0.7 part per million or more fluoride naturally present,
on one hand, and 0.2 part per million or less, on the other. No significant differ-
ence between the age adjusted death rates from cancer, heart disease, and
nephritis in the 28 high-fluoride cities and the rates in 60 low-fluoride cities could
be found.
(c) Studies of breast cancer incidence rates in 13 Texas cities divided into
3 groups according to fluoride content of drinliing water showed that the rate
was lower in cities with high fluoride content than in cities with low content.*
I trust the above provides you with helpful data. Needless to say, I shall be
glad to be of any furtlier help I can.
Sincerely yours,
Charles S. Cameron, M. D.
Appendix B
Policy of the American Dental Association
"Whereas numerous studies have demonstrated a decreased incidence of dental
decay associated with the presence of fluoride occurring naturally in drinking
water ; and
Whereas there is a rapidly accumulating body of data derived from direct
studies of the artificial addition of fluoride to drinking water ; and
Whereas these data provide convincing evidence of the safety of this pro-
cedure and of its benefits in terms of reduced incidence of dental caries : There-
fore be it
Resolved, That in the interest of public health, the American Dental Associa-
tion recommends the fluoridation of municipal water supplies when the fluorida-
tion procedure is approved by the local dental society and utilized in accordance
with the standards established by the responsible health authority ; and be it
further
Resolved, That the American Dental Association recommends the continuation
of controlled studies of the beneflts derived from the fluoridation of water
supplies.
Appendix C
Interassociation Committee on Health
1790 Broadway, New York 19, N. Y.
MBTMBER associations
American Dental Association
American Hospital Association
American Medical Association
Amei'ican Nurses Association
American Public Health Association
American Public Welfare Association
Statement op Interassociation Committee on Health
The following statement was unanimously approved by the member organiza-
tions of the Interassociation Committee on Health — American Dental Association,
American Hospital Association, American Medical Association, American Nurses
Association, American Public Health Association, American Public Welfare
Association :
» Same as footnote 3.
260 FLUORIDATION OF WATER
Since scientific reports published 35 years ago on tlie prevalence of endemic
dental fluorosis in the United States, evidence has accumulated demonstrating
the influence of small amounts of fluoride on dental health. Too much fluoride
in drinking water results in a condition known as dental fluorosis, or mottled
enamel; too little is associated with a high dental caries-experience rate. Be-
tween these two extremes, however, there is an optimum concentration of
fluoride of about 1 part per million which effectively prevents a substantial
amount of dental caries without causing dental fluorosis.
The prohlem of uncontrolled dental caries. — In the average community not
benefiting from fluorides in its water supply, up to 50 percent of the 2-year-old
children have 1 or more carious teeth, and the caries attack continues at a high
rate to the extent that 95 percent of the population is affected. Dental caries
results also in considerable cost for corrective dental services throughout an
individual's lifeime.
Unimpeded by preventive measures, dental caries creates a health problem of
considerable magnitude because of its high rate of occurrence and its numerous
sequelae that result from neglect. Dental defects thus created are accumulating
at a rate 4 to 5 times faster than can be corrected by presently available dental
personnel. Sound public health practice, therefore, requires a reduction in tlie
size of the problem by the use of effective preventive measures ; especially those
mea.sures which are applicable on a widespread basis and benefit all persons
in the community.
Epedemioloffical studies. — Epedemiological studies in many areas throughout
the United States and abroad have shown that, within certain limits, a con-
sistent inverse relationship exists between the fluoride content of drinking water
and the amount of dental caries experience in children, particularly those using
fluoride-bearing water continuously since birth. It has been found also that
a concentration greater than about 1 part per million, provides little, if any,
additional benefit. As the concentration increases beyond 2 parts per million,
an increasing number of persons has fluorosed enamel that is easily detectable.
Numerous investigations have shown that people reared in areas where drinking
water contains approximately 1 part per million of fluorine have experienced
only about one-third as much dental caries as those reared in areas where the
water supplies are fluorine free. Evidence indicates also that the benefits are
retained throughout life.
Studies on controlled fluoridation. — Studies begun in 1945 indicate that a
similar degree of protection against dental caries is found in areas where the
fluorine content has been adjusted to an optimum level as is found in areas where
the same concentrations occur naturally. Statistical data show a significant
reduction of dental caries in children and there is also evidence to suggest
some protection to the teeth of persons who were young adults when fluorida-
tion was undertaken. Continued observations will establish the ultimate degree
of effectiveness in older age groups who used fluoridated water during childhood.
Studies on safety of fluoridation. — There is extensive literature on the pharma-
cology and toxicology of fluorides. The reports include laboratory investiga-
tions as well as studies conducted among people who have lived continuously
in areas where the drinking water contains high concentrations of fluorides.
The most sensitive indication of an adverse physiological effect of fluoride
ingestion is an enamel defect known as dental fluorosis. Accumulated exi>eri-
ence provides no evidence that the prolonged ingestion of drinking water with
a mean concentration of fluorides below the level causing dental fluorosis has any
harmful effect.
A program involving the adjustment of the concentration of fluoride content
in the municipal water supply is especially practical and safe because it is
constantly subject to control by competent health authorities and does not
require action on the part of individual citizens.
Cost and enf/ineering aspects. — -The cost of fluoridation is small considering
its benefits. The cost of equipment has been found to range from several hundred
dollars for a small town to about $15,000 for a city of 2.500,000 persons. Annual
operating costs vary from 4 to 14 cents per person. These amounts are insig-
nificant when compared with the costs of dental corrective services throughout
a person's lifetime.
According to the American Waterworks Association, the addition of fluorides
to a municipal water supply is feasible from an engineering standpoint. The
mechanics of fluoridation are no more involved than those of water purification;
moreover, the machinery and equipment commonly used in water plants is
easily adapted. Through experience in towns and cities now fluoridating their
FLUORIDATION OF WATER
261
drinking water, standardized procedures have been developed vphich include
appropriate supervision by official health authorities.
Need for wider adoption of fluoridation. — Although studies are still being con-
ducted to determine the greatest amount of protection that may be realized
from fluoridation, there is ample evidence to justify its use in any community
where the water supply is deficient in fluorides and where tlie standards estab-
lished by the State and local health authorities can be met.
There is evidence that the beneficial effects of fluoride-bearing w^ater are
obtained only after several years of continuous use. Every year tbat fluorida-
tion is postponed, many thousands of children are deprived of the dental benefits
which they might otherwise have obtained.
In order that this effective, inexpensive, and safe public-health measure may
be adopted by additional communities as rapidly as possible, fluoridation must
receive the continuing and active support of all professional, civic, and official
organizations concerned with the health and welfare of the public.
National health organizations with 'policies favorable to fluoridation. — Ameri-
can Dental Association, American Medical Association, American Public Health
Association, American Association of Public Health Dentists, United States
Public Health Service, National Research Council, State and Territorial Health
Officers Association, and State and Territorial Dental Health Directors.
Resolved, That the Interassociation Committee on Health urges fluoridation
of the fluoride-deflcient public water supplies of this country as rapidly as plans
can be approved by the local medical, dental, and health department officials
and the State departments of health.
(Signed) George Bugbe:e,
Seoretary.
Appendix D
American Dental Association Council on Dental Health
STATUS OF fluoridation IN THE UNITED STATES, ITS TERRITORIES AND POSSESSIONS,
MAY 14, 1954 ^
In 944 communities in 43 States, the District of Columbia, the Panama Canal
Zone, and Puerto Rico 16,847,209 jversons are drinking water with controlled
amounts of fluoride added, according to reports received in the ADA central office.
In 1,152 communities in 44 States 3,570,021 persons are drinking water with
a natural content of 0.7 to 2.0 parts per million of fluoride."
In the United States, its Territories and possessions 20,417,330 persons are
drinking water containing optimum amounts of fluoride.
Approximately 105 million persons in the United States (66 percent of the total
United States population) are living in areas served by 16,750 public water
supplies."
In the United States 19.4 percent of the people served by public water supplies
are drinking water containing optimum amounts of fluoride.
Controlled amounts of fluoride are being added to the water supplies of the
following United States communities :
Sheffield
Tuscaloosa :
Holt
Northport
ARKANSAS
Arkadelphia
Camden
Jonesboro : Nettleton
Lewisville
ARKANSAS — Continued
Little Rock :
Camac Village
Guyer Springs
North Little Rock
Searcy :
Bald Knob
Judsonia
Springdale
Walnut Ridge
^ Inquiries for information on communities starting programs after May 14, 1954, should
be addressed to the respective State health departments or the U. S. Public Health Service,
Division of Dental Public Health, Washington 25, D. C.
^ USPHS report, March 31, 1953, PHS, IV and V.
NOTE. — Communities indented are served by community above.
262
FLUORIDATION OF WATER
CALIFORNIA
Antioch
Healdsburg
Morgan Hill
Pleasanton
Rio Vista
San Diego
San Francisco (part, approximately 60
percent)
COLORADO
Craig
Grand Junction
Gunnison
Johnstown
Lafayette
Lewisville
Montrose
Palisade
CONNECTICUT
Cromwell
Mansfield State Training School and
Hospital
Mystic :
Stonington Borough
Stonington Fire District
West Mystic
New Britain : Berlin
Southbury Training School
DELAWARE
Newark
DISTRICT OF COLUMBIA
Washington : Andrews Field
FLORIDA
Clewiston
Gainesville
Miami :
Coral Gables
Hialeah
Miami Beach
Miami Shores Village
Miami Springs
South Miami
West Miami
GEORGIA
Albany
Athens
De Kalb County :
Avondale
Brookhaven
Chamblee
Clarkston
Decatur
Doraville
Druid Hills (section of Atlanta)
Dunwoody
Norcross
Panthersville
Redan
Scottdale
Tucker
Fort Valley
Gainesville
GEORGIA — continued
Monroe
Rome
Rossville ^
I'ort Oglethorpe*
Part of Catoosa County *
Part of Walker County *
Waycross
IDAHO
Bonner's Ferry
Coeur d'Alene
Council
Lewiston
Lewiston Orchards
McCall
Montpelier
Orofino
Preston
Salmon
Sandpoint :
Kootenai
Ponderay
ILLINOIS
Assumption
Carboudale : DeSoto
Carlyle : Beckemeyer
Casey
Chester
Dixon State Hospital
Evanston : Skokie (part)
Kenilworth
Lansing (supplied by Hammond, Ind.)
Lawrenceville :
Bridgeport
Sumner
LeRoy
Morton Grove
Newton
Normal
Normal (part : Soldier's and sailor's
Children's Home)
Orion
Park Forest
Pleasant Hill
Sparta
Waukegan
Winnetka : Northfield
York Center
INDIANA
Batesville : Oldenburg
Bedford: Oolitic
Bloomfield
Columbus
Culver
Edgewood
Elkhart
Fort Wayne
Greensburg
Hammond :
Black Oak
Highland
Munster
1 Served by Chattanooga, Tenn.
FLUORIDATION OF WATER
263
INDIANA — continued
Huntingburg
Indianapolis :
Beech Grove
Ben Davis
Mars Hill
Mickleyville
Southiwrt
Suburban Township
Williams Creek
Woodruff Place
Jasonville :
Coalmont
Hymera
Kokomo
Lafayette
Lyons
Madison
Marion
Martinsville
Michigan City
New Carlisle
Tell City
Valparaiso : Flint Lake Water Co.
Walkerton
Zionsville
IOWA
Audubon
Cedar Rapids
Clarinda
Creston
Davenport : Bettendorf
Dubuque
Eagle Grove
Fairfield
Harlan
Hartley
Indianola
Iowa City:
Coralville
University Heights
Manchester
Perry
Waukon
KANSAS
Arkansas City
Coffeyville : South Coffeyville
Colony
El Dorado
Fort Scott
Garnett
Hays
Horton
lola:
Gas City
La Harpe
Junction City
Lawrence
Ottawa
Paola
Parsons
Seneca
KENTUCKY
Ashland
Burkesville
Calhoun
Central City
Cynthiana
Elizabethtown
Franklin
Glasgow
Greensburg
Hopkinsville
Lancaster
Louisville :
Avondale
Anchorage
Audubon Pai'k
Belmor
Beuchel
Glenview
Indian Hills
Jeffersontown
Kingsley
Lakeland
Lyndon
Middletown
Mockingbird
Preston
Seneca Vista
Shively
St. Matthews
Strathmore Manor
Strathmore Village
Martin
Mayfield
Maysville
Moorhead
Owensboro
Paintsville
Versailles
LOUISIANA
St. Martinville
Norway
MAINE
MAEYLAND
Baltimore and county :
Southern area :
Arbutus
Avalon
Baltimore Highlands
Crowdentown
English Consul
Halethorpe
Lansdovsme
Monumental
Relay
Rosemont
St. Denis
Catonsville area :
Catonsville
Harrlstown
Kenwood
Oak Forest
Paradise
264
FLUORIDATION OF WATER
MAEYi^AND — Continued
Baltimore and county — Continued
Piliesville ai'ea :
Colonial Park
Dumbarton
Fish town
Garrison
Hebbville
Howardsville
Larchmont
Lochearn
MLlford
Owings Mills
Pikesville
Ralston
Randallstown
Rockdale
Boslyn
Sudbrook Park
Villa Nova
Woodlawn
Reisterstown area :
Delight
Glyndon
Reistersto\Yn
Towson area :
Anneslie
Bare Hills
Baynesville
Cockeysville
Idlewild
Lake
Lakeside
Lutherville
Oakleigh
Padonia
Pinehurst
Riderwood
Rockland
Rogers Forge
Ruxton
"Sheppard
Stoneleigh
Texas
Timonium
Towson
Wiltondale
Woodbrook
Parkville area :
Carney
Cub Hill
Fullerton
Kenwood Park
Lavender Hill
Linhigh
Necker
Overlea
Parkville
Perry Hall
Putty Hill
Middle River area :
Aero Acres
Bengies
Glenmar Manor
Middle River
Stanbury
Victory Villa
MARYLAND — Continued
Baltimore and county — Continued
Essex area :
Chesaco Park
Essex
Golden Ring
Middleborough
Rosedale
Rossville
Stemmers Run
Walters
Dundalk area :
Balnew
Dundalk
Fairtown
Harbor View
Iverness
St. Helena
Stab
Turner
North Point area :
Edgemere
Lynch Point
Lodge Forest
North Point
Fitzell
Anne Arundel County :
Arundel Village
Brooklyn Park
Howard County :
Elkridge
Harwood
West Elkridge
Bel Air
Frederick
Hagerstown :
Cavetown
Funkstown
Halfway
Roxbury Penal Farm
Security
Smithsburg
Williamsport
Maryland Suburban Sanitary Dis-
trict :
Alta Vista
Ardwick
Beltsville
Berwyn
Bethesda
Bladensburg
Brookmont
Bradbury Boulevard
Bradbury Heights
Burnt Mills Village
Cabin John
Cabin John Park
Capitol Heights
Central Avenue
Cheverly
Chevy Chase
Chillum
College Park
Edmondson
Forest Glen
Forest Heights
FLUORIDATION OF WATER
265
MARYLAND — Continued
Maryland Suburban Sanitary
trict — Continued
Forestville
Four Corners
Gaithersburg
Garrett Park
Glendale
Glen Echo
Glen Mont
Greenbelt
Hampshire Gardens
Hillendale
Hyattsville
Kenilworth
Kensington
Kenwood
Landover
Lanham
Laurel
Lenox
Montgomery Hills
Mount Euuier
Riggs Road
Seat Pleasent
"Silver Hills
Silver Spring
.Suitiuiul
Takoma Park
Viers Mill
Washington Grove
West Gabe
Wheaton
Wood Acres
MASSACHUSETTS
Athol
BelchertOYi-n State School
Beverly
Concord (part)
Danvers : Middleton
Hinaham : Hull
Medway
North Andover
Salem
Seekonk
Sharon
Shrewsbury
Templeton
Tops field
Wrentham State School
MICHIGAN
Algonac : Pearl Beach
Ann Arbor
Battle Creek
Bay City: Essexville
P.euton PlarlKir
Buchanan
Charlevoix
Gladstone
Grand Haven
Grand Rapids :
Cascadia
East Leonard Heights
TJrbondale
MICHIGAN — continued
Dis- Grandville
Grosse Pointe Farms : Grosse Pointe
Hastings
Highland Park
Hillsdale
Ishi>eming
Jackson
Kalamazoo (part)
Lake Odessa
Ludington : Epworth Heights
Mancelona
JMarquette
Marysville
Midland
Monroe
Mount Clemens : Harrison Township
Musikegon
Muskegon Heights: North Muskegon
Heights
Negaunee
Saginaw
St. Joseph
South Haven
Stambaugh : Stambaugh Township
Traverse City
Wyandotte
MINNESOTA
Appleton
Arlington
Austin
Benson
Blue Earth
Circle Pines
Cloquet : Scanlon
Crookston
Ely
Fairmont
Faribault
Fergus Falls
Granite Falls
Hallock
Hutchinson
International Falls: South Interna-
tional Falls
Madison
Mapleton
Montevideo
Mora
Morris
New York Mills
Okabena
Perham
lied Lake Falls
Rush Citv
St. Pnnl :
RoseviUe
West St. Paul
Staples
Thief River Falls
West Concord
Winnebago
266
FLUORIDATION OF WATER
MISSISSIPPI
NEW YORK — continued
Columbus
Forest
Meridian
Bozeman
Chinoolc
Fort Belknap
Roundup
Beatrice
Fairbury
Nebraska City
Superior
MONTANA
NEBRASKA
Concord
NEW HAMPSHIRE
NEW JERSEY
City of Asbury Park
Borough of Bradley Beach
Boi-ough of Deal
Borough of Eatontown
Borough of Fair Haven
Borough of Interlaken
Borough of Little Silver
City of Long Branch
Township of Middletown
Borough of Monmouth Beach
Morristown :
Hanover Township
Morris Plains
Morris Township
Borough of Neptune City
Township of N'eptune
Borough of New Shrewsbury
Township of Ocean
Borough of Oceanport
Rahway
Borough of Rumson
Borough of Sea Bright
Borough of Shrewsbury
Township of Shrewsbury
Borough of West Long Branch
NEW YORK
Amsterdam
Carle Place
Cobleskill
Elmira
Fulton
Gloversville
Highland
Hoosick Falls
Larchmont
Levittown (Levittown-Island
Water District)
Newburgh
New Rochelle:
Ardsley
Bronxville
Eastchester
North Pelham
Pelham
Pelham Manor
Tuckahoe
Trees
Clean
Penn Yan
Plattsburgh
Poughkeepsie
Rochester
Schenectady
Westfield
NORTH CAROLINA
Albemarle
Charlotte :
Morris Field
Pineville
Concord
Dunn
Fayetteville
Greensboro
Hamilton Lakes
Guilford College
Hickory
High Point
Lenoir
Lexington
Roanoke Rapids
Rockingham
Rocky Mount
Salisbury
Southern Pines
Sylva
Winston-Salem
NORTH DAKOTA
Dickinson
Fargo
Mandan
Northwood
Riverdale
Williston
OHIO
Avon Lake
Canfield
Canton : Meyers Lake
Chesapeake (supplied by Huntington,
W. Va.)
Elyria
Glendale
Hamilton
Ironton : Coal Grove
Jackson
Lisbon
McDonald
Martins Ferry:
Bridgeport
Brookside
Medina
Niles
Oberlin
Portsmouth
Westerville
Wyoming
Youngstown: Suburban Township
FLUORIDATION OF WATER
267
OKLAHOMA
Altiis
Ardmore
Bartlesville
Clinton
Guthrie
Mangum
Nowata
Tulsa
OREGON
Astoria
Corvallis : Philomath
Florence
Forest Grove
Gearhart
Mill City
Pendleton
Salem Heights Water District
PANAMA CANAL ZONE
PENNSYLVANIA
Brookville
Easton :
Bethlehem Township (part)
Forks Township (part)
Glendou Borough
Palmer Borough
West Easton Borough
Williams Townshii> (part)
Wilson Borough
Ebensburg
Ford City : Manorville
Mansfield
Millersburg
Natrona :
Harrison (part)
East Deer Township (part)
New Castle :
Hickory Township
Neshannock Township
Shenago Township
South New Castle Borough
Union Township
Pittsburgh :
Blawnox
Bruceton
Homestead
Moon Run
Mount Troy
O'Hara Township
Reserve Township
Robinson Township
Snowden Township
Woodville
Ridgway
Uniontown
Wilkinsburg :
Braddock (part)
Braddock Township (part)
Chalfant
Churchill
East McKeesport
East Pittsburgh
Edgewood
Forest Hills
PENNSYLVANLi — Continued
Pittsburgh — Continued
Wilkinsburg — Continued
North Braddock
North Versailles Township
Patton
I'enn Township
Pitcairn
Rankin
Swissvale
Tra fiord
Turtle Creek
Williams Township
Wilmerding
Also supplies 13 wards in
Pittsburgh
PUERTO RICO
Guaynaho :
Bayamon
Catano
San Juan
Trujillo Alto :
Carolina
Loiza
Rio Grande
Rio Piedras
RHODE ISLAND
Bristol :
Barrington
Warren
Newport: Middletown
Providence :
Cranston
Johnston
North Providence
Smithfield
Warwick
SOUTH CAROLINA
Cheraw
J^ort Mill
Greenville (Greater Greenville) :
Donaldson Air Force Base
Fountain Inn
Marietta
Mauldin
Renfrew
Rural
Simpsonville
Slater
Travelers Rest
Hartsville
Lancaster
Ninety Six
Orangeburg
Rock Hill
SOUTH DAKOTA
Aberdeen
Mobridge
Vermillion
Watertown
48391—54-
-18
268
FLUORIDATION OF WATER
TENNESSEE
Bristol
Brownsville
Chattanooga :
East Brainerd
East Ridge
Hixon
Lookout Mountain
Signal Mountain
Cleveland
Cookeville
Covpan
Crossville
(iermantown
Lawrenceburg
Milan
Nashville :
Belle Meade
Woodbine
Oak Ridge
Paris
Tiptonville
Union City
Winchester
TEXAS
Breckenridge
Corpus Christi
Gonzales
Graham
Iowa Park
Marshall
I'aris
Port Arthur :
Groves
Lakeview
Sabine Pass
Sweetwater
Temple
Wellington
Wichita Falls
* VERMONT
Burlington
VIRGINIA
Alexandria , ^ -m- a,
Arlington County (supplied by Wash-
ington, D. C.)
Blackstone
Charlottesville
Danville , ,„ ^. i.
Falls Church ( supplied by Washington,
D. C.)
Fredericksburg
Fries : Blair Addition
Lyuchbvu-g :
Madison Heights
State Colony
Norfolk :
Port Lock
South Norfolk
Virginia Beach
Portsmouth :
Churchland
Craddock
Alexandria Park
Deep Creek
VIRGINIA — continued
Simonsdale
Suffolk
West Norfolk
Richmond : Lakeside
Winchester
WASHINGTON
Clarkston
Norwood Village
WEST VIRGINIA
Bridgeport
Clarksburg
Fairmont :
Grant Town
Rivesville
Huntington : Barboursville
Logan
Martinsburg
Matewan
Parkersburg
Pineville
Ripley
Sistersville
Weirton
Wheeling:
Benwood
Bethlehem
Tridelphia
Valley Grove
Williamson
Williamstown
WISCONSIIT
Alma
Amery
Antigo
Appleton
Belle Heights
Bucholz
Whispering Pines
Argyle
Ashland
. Athens
Baraboo
Lyons
Beaver Dam •
Belleville
Beloit
Berlin
Black River Falls
Blair
Bloomer
Boscobel
Cambridge
Cedar Grove
Columbus
Cottage Grove
Crestwood
CMba City
Darlington
DeForest
Delavan
FLUORIDATION OF WATER
269
WISCONSIN — continued
Dodgeville
Eagle River
T]au Claire
Edgar
Edgerton
Elkhorn
Evansville
Fond du Lac
Fort Atkinson
Galesville
Gillette
Hartford
Hayward
Horicon
Janesville
Lake Geneva
Xiodi
Madison
Blooming Grove Sanitary District
Burke
Garden Homes
Lakeview Sanitary District
Maple BlufE
Monona
Oak Ridge Sanitary District
Shorewood Hills
Marinette
Marshfield
Mayville
Mazomanie
Menaslia
Menomonee Falls
Middleton
Middleton Sanitary District
Milton
Milton Junction
Milwaukee
Fox Point
Shorewood
Wauwatosa (partial)
West Allis
West Milwaukee
Whitefish Bay
Mineral Point
Mosinee
Mount Horeb
Mukwonago
Xeenah
New Glarus
WISCONSIN — continued
New Holstein
Oconomowoc
Oregon
Orfordville
Osceola
Oshkosh
Pewaukee
Phillips
Platteville
Portage
Port Washington
Poynette
Prairie du Sac
Racine
Colonial Heights Sanitary District
North Bay Sanitary District
South Lawn
Reedsburg
Rhinelander
Rice Lake
Richland Center
Ripon
Sheboygan
Sheboygan Falls
Shell Lake
Soldiers Grove
South Milwaukee
Sparta
Spooner
Spring Green
Stoughton
Sun Prairie
Tomahawk
Trempealeau
Watertown
Waunakee
Waupun
Wausau
West Bend
Barton
Westby
Weyauwega
Whitehall
Wisconsin Rapids
Wonewoc
WYOMING
Laramie
Sinclair
Thermopolis
The Chairman. Are there any questions by members of the
committee ?
Mr. Heselton. Doctor, there is one point I would like to mention :
In appendix C, reference is made to the action taken by the Inter-
Association on Health, and I notice among the members of that asso-
ciation is the American Medical Association.
Dr. Gale. Yes.
Mr. Heselton. There has been some statement of approving the
matter in principle by the American Medical Association. This
statement, I notice, that you filed was dated May 5, 1954. Does that
I''
270 FLUORIDATION OF WATER
represent the present position of the American Medical Associations
approval of the association committee on health ?
Dr. Gale. I do not think I quite understood the question.
Mr. Heselton. I will try to rephrase it. You have made, by-
reference, a statement concerning the American Medical Association.
Dr. Gale. Yes.
Mr. Heselton. As being a member of the Inter- Association Com-
mittee on Health.
Dr. Gale. Yes.
Mr. Heselton. My recollection is that there has been some testi-
mony that the American Medical Association has taken a position
that was one of qualified approval and this statement is dated May 6^
1954. I would be interested to Imow whether this supersedes the
previous statement that has been submitted to the committee.
Dr. Gale. May I read to you, sir, a letter here signed by George F.
Lull, who is secretary of the association, to Dr. H. L. Bloom
Mr. Heselton. Secretary of which association ?
Dr. Gale (reading) :
I have your letter of April 6, written by your assistant —
and so forth.
This statement is as follows :
I can say that the American Medical Association endorses the fluoridation of
public water supply. George Smith and many others have twisted the words
around because of the fact that in one action of the house of delegates, the
word "principle" was used.
No matter what words were used, the endorsement is that public water
supply should be fluoridated in order to prevent dental caries in children.
Does that answer your question ?
Mr. Heselton. The secretary of the association ? Was that of the
American Medical Association ?
Dr. Gale. I think it was.
Mr. Garvey. Secretary and general manager of the American
Medical Association.
Mr. Heselton. Wliat date was that ?
Dr. Gale. That was April 14, 1954.
Mr. Garvey. May I say also, Mr. Heselton, that Dr. Lull has filed
a statement with the chairman of this committee on behalf of the
American Medical Association to the same effect, and asked that it
be incorporated in the record.
The Chairman. It is already a part of the record.
Mr. Williams. Mr. Chairman.
The Chairman. Mr. Williams.
Mr. Williams. Doctor, I believe you represent the American Dental
Association?
Dr. Gale. That is correct.
Mr. Williams. And the American Dental Association has taken a
position in favor of — or certainly not objecting to — fluoridation ?
Dr. Gale. In favor of.
Mr. Williams. In taking that position, Doctor, does the American
Dental Association have anything in mind other than a sincere desire
to promote dental health ?
Dr. Gale. No, sir ; I firmly believe that the American Dental Asso-
ciation in recognition of its responsibility to the general public in the
FLUORIDATION OF WATER 271
matter of health — they have ahvays been as much interested in pre-
venting dental diseases as they have been in curing dental diseases.
Mr. Williams. Doctor, the effects of fluoridation are known, I
presume ?
Dr. Gale. I can say from my own experience, and I may be encroach-
ing perhaps on someone who can better express this later, but from
my own experience in the new experiment in Newberg which has been
referred to before, I know that if it is to be termed an experiment, has
been conducted by the full health team, and it has not been conducted
by the dental department, but by the full health team, wdiere they were
constantly X-raying, blood tests taken, and medical tests taken, as the
work went on.
So that we are quite sure of the safety of the application of the use
of the fluorides in water.
Mr, Williams. Has any tangible evidence ever been presented to you
-on which to base a finding to the effect that fluoridation is harmful ?
Dr. Gale. No. Harmful ? No.
Mr. Williams. On the other hand, I presume that affirmative evi-
dence has been presented as to its benefits ?
Dr. GxVLE. I would say that when the State health department per-
sonally supervised — with a full medical team, because they are inter-
ested not in the matter of dental caries alone, but in the entire health
picture of the State — that they would be the last people in the world to
allow a thing of that kind to continue if there w^as even the smallest
evidence there was any physical danger attached.
]Mr. Williams. Doctor, not being a scientist or a doctor, I am won-
dering why there are such diverse opinions among the men in the
medical association concerning the effect of fluoridation.
Dr. Gale. I might say, so are we, and I do not mean to be dodging
the question, sir.
Mr. Williams. I understand. That is a very good answer, I think.
I asked you the question as to what motive the American Dental
Association might have in supporting fluoridation, other than to
promote the dental health of the people of America, and your answer
was "None.'
On the other hand, do you know of any ulterior motive of any kind,
which might be behind the opposition to the fluoridation of water,
other than a sincere desire on their part to protect the dental and
physical health of the people ?
Dr. Gale. I cannot say that I do know of any.
Mr. Williams. Then it is your opinion, that it is just a simple, but
open, difference of opinion among the men in medicine?
Dr. Gale. And, let us hope, an honest difference of opinion.
IVIr. Williams. That is all, Mr. Chairman.
The Chairman. Any further questions ?
Mr. Hale?
Mr. Hale. Doctor, there was some testimony here this morning, if
I understood it correctly — and I am not sure that I did, but if I
did understand it, it was that the fluoridation benefits to children's
teeth is for a period up to 7, or say 8, years of age, and after that,
that it does more harm than good. Would you comment on that ?
Dr. Gale. I think I would prefer, perhaps, to have one of the
gentlemen who follow me make a comment on that. I might say.
272 FLUORIDATION OF WATER
though, that if you will remember, that statement was made by a
gentleman who admitted that he was not of the dental profession.
And it is a well recognized fact in dentistry that the ages of perhaps
10 to 14 and 15 are the ages when there is the highest incidence of
dental caries under any conditions, because that is the time the child
is developing most rapidly, and the teeth are called upon to supply
so many needs of the body, so it is not surprising to us that tliere
might be an increase in the instance of dental caries in that age. The
differentiation being whether or not, under the fluoride program, it
was still, to some degree, a control, whereas, without control, it would
have existed to a much greater extent.
]Mr. Hale. Just so that we may have it in the record, can you tell
the committee without too much technical language, what dental
caries is ? What causes it, and what it does to our general health ^
Dr. Gale. Well, I could give you — I will attempt to give you in
layman language, the most commonly accepted theory of dental decay,
that being
Mr. Hale. Caries means decay ?
Dr. Gale. Dental caries is dental decay, yes; they are synonymous
terms. The most accepted theory is, of course, that the enamel is
broken down by the acids in the mouth, formed perhaps in the initial
stages of digestion with sugars and carbohydrates and by the bac-
teria invasion of the dentine of the teeth; and in the days when I
went to school, unless they have changed it, they used to say that
bacteria thrives on the albuminous constituents of the dentine, and
hence you have the breaking down of the teeth.
Now, may I say this off the record, please ?
( Discussion oft' the record. )
Mr. Hale. Anyway, the tooth decay sets in, or may set in, at least
almost as soon as the infant acquires teeth; is that correct?
Dr. Gale. That is true. In fact, many children between two and
two and a half liave mild incidence of decay.
Mr. Hale. And then when the permanent teeth come, they have
to start all over again ?
Mr. Gale. Many times.
Mr. Hale. I believe that is all, Mr. Chairman.
Mr. Williams. Mr. Chairman.
The Chairman. Mr. Williams.
Mr. Williams. Doctor, you heard the testimony a few moments ago
of Dr. Ginn. I believe you were in the room, were you not?
Dr. Gale. Yes.
Mr, Williams. Dr. Ginn, if I recall correctly, presented as an ex-
hibit to his testimony, two sets of teeth : one set allegedly taken from a
continuous user of fluorinated water, and the other set from a person
who had not used drinking water with fluorine in it. I believe it was
his intention in presenting the two sets of teeth to show that in one set
of teeth, the teeth were in bad shape, and I believe that the other was in
good shape. One set was sound and the other set was unsound, and he
attributed the condition of the bad set of teeth to fluorination. I be-
lieve he challenged any member of the dental profession to contradict
his statement to the effect, I believe, that the teeth which had been
subjected to fluorination were solvent in some kind of acid and that
the others were not. Would you care to comment on that ?
FLUORIDATION OF WATER 273
Dr. Gale. I ^Yould much prefer, if it meets with your peniiission,
to defer that question to one of the members of the profession who
will follow me, Dr. Doty, or Dr. Dean, either one of whom, I am
sure, can answer the question to your satisfaction.
Mr. Williams. I would like to hear some qualified witness elaborate
on that subject.
Dr. Gale. Yes.
Mr. Williams. And to explain to the committee the significance of
such testimony.
Dr. Gale. I tliink it is insignificant, but I would prefer to have
the gentlemen who follow me cover it.
Mr. Williams. Unfortunately, we are not expert in this particular
field, so we have to rely upon those whom we know to be expert.
Dr. Gale. Yes.
The Chairman. Any further questions? If not, we thank you.
Dr. Gale. Thank you.
STATEMENT OF DR. H. TRENDLEY DEAN, SECRETARY, COUNCIL ON
DENTAL RESEARCH OF THE AMERICAN DENTAL ASSOCIATION
Mr. Garvey. Mr. Chairman, the next witness will be Dr. Trendley
Dean, secretary of the Council on Dental Research and Therapeutics
of the American Dental Association.
The Chairman. Dr. Dean, you may proceed.
Dr. Dean. Mr. Chairman and members of the committee, it is a
pleasure, Mr. Chairman, to appear before this committee and discuss
the relation of fluorine to dental health. I am H. Trendley Dean,,
secretary of the Council on Dental Research of the American Dental
Association, Chicago, 111. I graduated in dentistry from the St. Louis
University in 1916. For more than 20 years my efforts have been
devoted to the study of fluorine and dental health. A list of 46 of
my papers dealing with this subject as recorded in the periodical
literature is attached to this statement. A listing of 8 chapters con-
tributed to 6 dift'erent books is contained in my curriculum vitae which
is likewise attached.
The disclosure of the fluorine-dental caries relationship resulted
from field epidemiological studies. For the benefit of the committee,
may I very briefly define the modern concept of epidemiology.
Through long common usage the term "epidemiology" came to mean
the study of epidemics, or of diseases characterized by a sharply in-
creased case incidence within a relatively short period of time. Today
this concept no longer obtains. The past generation has been the hori-
zon of epidemiology markedly expanded, particularly in the field of
environmental factors affecting man. Epidemiology has, in fact, be-
come medical ecology, and this method of study is being applied to
the study of any mass disease or condition, the cause of which may be
known, suspected, assumed or unknown.^ ^
For those unfamiliar with epidemiological procedures, one point
might well be stressed : A population of individuals constitutes the
1 Gordon, J. E, : IV. The Twentieth Century — Yesterday, Today, and Tomorrow (1020 — ),
In The History of American Epidemiology. Top. F. H.. ed., C. V. Mosby Co., St. Lonis. 1952.
- Clark, E. G. : An Epidemiologic Approach to Preventive Medicine, in, Textbood of
Preventive Medicine, Leavell, II. R., and Clark, E. G., McGraw-Hill Book Co., Inc., New
York, Toronto, London, 1953.
274 FLUORIDATION OF WATER
unit of investigation. This is in distinct contrast to the clinical
method in whicli the individual, rather than a population of individ-
uals, is the basis of study. In an epidemiological inquiry, all observa-
tions are related to the group; in a clinical study, the observations
remain related to the particular individuals under study.
Epidemiological observations are particularly concerned with op-
erations of nature and man's reactions to the nature around him.
Naturally man's environment is an ensemble of extreme complexity;
hence, it is essential that we utilize all the scientific disciplines per-
tinent to an explanation of the phenomenon under observation. When
marked differences are observed in health and disease, one naturally
asks what different factors, causal or otherwise, may be operating
in these several populations. Thoroughgoing studies of certain of
these phenomena in nature have provided some of the outstanding con-
trol measures in preventive medicine, that is, cowpox virus as a pre-
ventive for smallpox, citrus fruits for scurvy, iodine for endemic
goiter, quinine for malaria, and fluorides for dental caries control.
Mottled enamel, or the dental manifestation of an excessive intake
of fluorides during the calcification period of the teeth, has been
known for at least a half century. The first report in the United
States literature was that of Eager ^ in 1901, describing an endemic
area in Italy. The classical studies of McKay and Black* in this
country appeared in 191G. Other studies on mottled enamel included
the extensive work by Argentinian, North African, and Japanese
workers in the 1920's, while in the early 1930's reports of studies in
England, Italy, and China appeared.
In 1931, 3 independent investigators, 2 in the United States and 1 in
north Africa, reported that excessive amounts of fluoride in the drink-
ing water was the causative factor. Subsequent research demon-
strated the quantitative relationship between the fluoride concentra-
tion of the drinking water, and the prevalence and severity of endemic
dental fluorosis, as mottled enamel was subsequently termed. It was
also demonstrated quantitatively that under average water consump-
tion and climatological conditions in the United States a concentra-
tion of 1.0 part per million in the drinking water was not associated
with the development of mottled enamel.^
The relation of fluorides to dental caries has been intensively studied
for more than 20 years.*^ The earlier mottled enamel studies were con-
cerned with the dental effects resulting from the use of domestic waters
containing too much fluorides. In these early studies one fact kept
continuously recurring, the repeated observation that the amount of
dental caries (decay) was lower in endemic mottled enamel areas than
in areas not affected. The universality of this observation suggested
that nature was showing the way to a new control measure. Not only
was this phenomenon observed in the United States but in the Argen-
tine, in England, and in Japan as well.
3 Eager, J. M. : Denti di Chiaie (Chlaie Teeth). Public Health Report 16: 2576-2577,
November 1, 1901.
* MoKav, F. S. : (in collaboration with Black, G. V.) : An Investigation of Mottled Teeth :
an endem'ic developmental imperfection of the enamel of the teeth, heretofore unknown in
the literature of dentistry. Dental Cosmos, 58: 477-484 (a) May; 027-644 (b) June;
781-792 (c) July ; 894-904 (d) August 1916.
s Fluorine and Dental Health : F. R. Moulton, editor, publication No. 19, American Asso-
ciation for the Advancement of Science, Science Press, Lancaster. Pa., 1942.
« Dental Caries and Fluorine : F. R. Moulton, editor, American Association for the
Advancement of Science, Science Press, Lancaster, Pa., 1946.
FLUORIDATION OF WATER 275
Accordingly a compreliensive epidemiological study was planned
and carried out by the dental research group of the National Institutes
of Health. These studies culminated in an examination of 7,257 con-
tinuous resident white children of 21 cities with differing amounts of
fluorides in their community water supplies. These studies established
two facts of basic importance : "^
(a) Children 12-14 years of age who have continually, since birth,
used a domestic water with an optimal fluoride concentration have, in
general, only one-third of the amount of dental caries as do the same
age groups who used fluoride-free domestic waters; and
(h) that this markedly lessened amount of dental caries follows
the use of a communal water supply containing as little as 1.0 parts
per million of fluoride — a fluoride concentration sufficiently low to ob-
viate the development of dental fluorosis or mottled enamel.
Marked inhibition of dental caries has likewise been observed in
adult populations. The frequently made statement that fluoridation
is applicable only to children is not true in the light of more recent
studies. Russell and Elvove ^ made a detailed epidemiological study
of adults with a history of continuous residence in Boulder, Colo.,
where the domestic water supply was fluoride- free, and in Colorado
Springs, Colo., where for the past 60 years the public water supply
contained 2.5 parts per million of fluoride. This study showed that
adults of Colorado Springs in the 35-39 and the 40-44-year-old-groups
had only one-fourth the amount of dental decay and one-fourth the
tooth loss as the same age groups at Boulder.
The data from innumerable epidemiological studies were critically
analyzed. Much supporting evidence came from the laboratory; ex-
perimental dental caries in animals was similarly inhibited when
fluorides were added to a caries-producing diet. Obviously, the next
step would be an attempt to simulate this purely natural phenomenon
by adjusting the chemical composition (fluoride) of a public water
supply to conform to that where nature itself has provided such out-
standing evidence of protection against the attacks of dental caries.
Water fluoridation, or the treatment process of adjusting the fluoride
concentration of a public water supply to a level optimal for dental
health, began in 1945. Today water fluoridation is an acceptable
public-health procedure;^ as of May 1, 1954, fluoridation is being
practiced in 944 communities of the United States with a population
of nearly 17 million persons.^" It should not be overlooked that in ad-
dition there are about 3,500,000 other people in this country who re-
side in areas where the public water supply carries fluorides in optimal
or higher amounts.
The three cities where fluoridation has been under study since 1945
are Grand Rapilds, Mich., Newburgh, N. Y., and Brantford, Ontario
' Dean, H. T., Arnold, F. A., Jr., and Elvove, E. : Domestic Water and Dental Caries.
V. Additional studies of the relation of fluoride domestic waters to dental caries experience
In 4,425 -white children, age 12 to 14 years, of 13 cities in 4 States. Public Health Report,
57: 1155-1179 (August 7), 1942. ^, . , ^
8Russoll, A. L., and Elvove, E. : Domestic Water and Dental Caries, VII. A study of
the fluoride-dental caries relationship in an adult population. Public Health Reports, 66 :
1389-1401, October 26, 1951.
0 Report of the ad hoc Committee on Fluoridation of Water Supplies. Publication 214,
Division of Medical Sciences, National Academy of Sciences-National Research Council,
Washington, D. C. 1952. „ ^
1* Information Bulletin, American Dental Association, Chicago, III., May 1954.
276 FLUORIDATION OF WATER
(Canada). A recent report" shows that at Grand Eapids there has
been a reduction in the amonnt of dental caries in the 6, 7, 8, and 9
year okl children of the order of 70.8, 52.5, 49.2, and 48.1 percent, re-
spectively. In the case of Brantforcl, the reduction observed in the
same age groups was 59.4, 69.5, 51.5, and 46.2 percent, respectively.
The 6, 7, 8, ancl 9 year old groups at Newburgh shows a reduction of
69.4, 67.8, 40.4, and 51.4 percent, respectively. The number of children
examined in each city was ample for statistical analysis. Such con-
sistency in these and other independent studies suj^plies direct evi-
dence that dental decay and much of its sequelae can be brought under
a large measure of control through fluoridation of the public water
supply.
From time to time the question is raised : Fluoridation is mass medi-
cation. Such is not the case, and any assumption that it is reveals a
lack of knowledge of the carious process and its associated path-
ology. Medication implies the application of a medicinal substance
or agent for the treatment and cure of a disease — the application of
remedies. Fluoridation is not a treatment or cure for dental caries.
Dental caries is a nonhealing lesion; dental enamel once injured never
repairs itself, with or without medication. Fluorine simply prevents
the decay from developing. In short, fluoridation of public water
supplies simulates a purely natural phenomenon — a prophylaxis
which nature has clearly outlined in those communities that are for-
tunate enough to have about one part per million of fluoride naturally
present in the public water supply, such as, for example, Denver,
Colo., Aurora, 111., and many others.
The conclusions contained in a recent article ^^ summarize my
present thinking on this subject. May I quote it verbatim :
CONCLUSIONS
1. In relation to dental health, public water supplies may now be divided into
three groups :
(a) Those carrying naturally the optimal concentration of fluoride, or those
waters deficient in fluoride which have been adjusted to the optimal by fluori-
dation.
(ft) Those carrying an excessive amount of fluorides, requiring the removal of
the excess in order to protect tlie community against endemic dental fluorosis
(mottled enamel) ; or
(c) Those deficient in fluoride, to which should be added fluoride to bring
their concentration up to the level optimal for dental caries control.
2. Dentistry now has a proven partial control measure for the most ubiquitous
of diseases, dental caries. Fluoridation is a cheap, tfCective dental-caries pre-
ventive heralding marked changes in the dental practice of the future. Such
■changes may be as revolutionary as those which have occurred in medicine during
the past generation with the advent of immunization and the antibiotics. With
dental caries brought under a large measure of control, the dentistry of tomor-
row may well be drawn more and more into the biological aspects of oral medi-
cine and its consequent effect, the development of preventive dentistry.
" The Problem of Providing Optimum Fhioride Intake for Prevention of Dental Caries.
A report of the committee on dental health of the Food and Nutrition Board prepared by
the Subcommittee on Optimum Fluoride Levels. Division of Biology and Agriculture,
National Research Council, Publication 294, November 1953, Washington, D. C.
^ Dean, H. T. : Fluorine in the Control of Dental Caries — Some aspects of the epidemi-
ology of the fluorine-dental caries relationship. International Dent. J., 4 : 311-337, March
1954.
FLUORIDATION OF WATER 277
H. Tren'dley Dean, March 1954
Specialism listing : Epidemiology
Otlier specialisms : Flourine and dental health
Vincent's infection
Research Administration
Radium dial painter's poisoning
Mandibular fractures
Dean, Dr. H(enr.v) Trendley ; epidemiology; born Winstanley Park (now part
■of East St. Louis), St. Clair County, 111., August 25, 1893; son William Ware and
Rosalie Harriet (Trendley) D. ; ed. St. Louis Acad. (St. L. Univ.) 08-12 ; D. D. S.,
St. Louis Univ., 1916 ; Officers School, U. S. Public Health Service, 19:^1 ; m. Rutli
Martha McEvoy, September 14, 1921 ; children — Ruth Celestiue, Dorothea Vir-
ginia (Mrs. D. R. McKiernan), Mary Harriet. Licensed to practice in Missouri
and Illinois. Private practice. Wood River, 111., 1916 and 1920 (Pres., Alton, III.,
Dental Snciety, 1920; Post Commander, Wood River Post, American Legion,
1920 ) . Acting Assistant Dental Surgeon U. S. Public Health Service, 21-22 ; U. S.
Veterans" Bureau, 23 ; Acting Asst. Dental Surgeon, USPHS, 24-2.1 ; passed asst.
dental surgeon, 20-30, dental surgeon, 30-42, senior dental surgeon, 42-45, dental
director. 45-53; Dental Director, retired 1953; Secretory, Council on Dental
EefiCdrch. American Dental As.sn., 1953-; served at U. S. Marine Hospital, St.
Louis, Mo.. Fort William Henry Harrison, Montana, U. S. Marine Hosps., Boston,
JVIass. ; New York, New York ; San Francisco, Calif. ; and Nat. Inst, of Health,
Washington, D. C, and Bethesda, Md.
On duty National Institute of Health 1931-53 serving in division infectious
'diseases, division physiology, and later Experimental Biology and Medicine
Institute. Director, National Institute of Dental Research, 1948-53. Fellow,
A. A. A. S. (Council, 1953- ) ; Am. Coll. Dent. (Chairman, Wash. Sect. 41;
assoc. ed. Jour. Am. Coll. Dent, 40—18; Coram, research, 50-) ; Am. Pub. Health
Assn. (comm. on research and standards, 49-52) ; mem.. Am. Dent. Assn. (secy.,
coram, dental health surv. 33-35 ; military affairs, 37 ; mem. economics comm.
38-48; research commission, 39—48); International Assn. Dental Research,
pres. 44: trustee. 48- ) ; Washington Acad. Sciences, Assn. Military Surg. (Pres.
1937, Assn. Mil. Dental Surg, of U. S.) ; Am. Epidemiol. Soc, National Research
•Council (mem. comm. div. med. sci., 43-48; Ad Hoc Committee on Fluoridation
of water supplies, 1951, NRC, Division of Medical Sciences) ; Federation Dentaire
Internationale (v. p. from U. S. 1947-52 ; co-opted member, Scient. Comm. 1953- ) ;
Amer. Assn. Dental Editors, 4(5-48 ; Amer. Water Works Assn., comm. policy re
■fluoridation of public water supplies, 49- ; Professorial Ijccturer, Epidemiology,
Univ. Chicago, 1953- ; Delta Sigma Delta (life mem.) ; Omicron Kappa Upsilon
(hon.). U. S. Army, 1917-19, Ft. Rilev, Kans. ; Camp Logan, Tex.; Ft. Sill,
Okla. ; 1st It. and capt. DRC. ; 20th U. S. Cavalry (78th F A.) and 3d F. A.,
A. E. F. in France, World War I; detailed (as Col. USPHS on temp, duty) to
■O. M. G. (P. H. Br.) Hdqrs., U. S. Forces, European Theater (Main), U. S.
Zone Germany, World War II, 4.5^6.
Lecturer, U. S. Navy Dental School, 1943^8; Lecturer, U. S. Army Dental
School. 1948-49. Gorgas Medal and Award (Assn. Mil. Surg. 1949) ; John M.
Goodell Prize (AWWA, 1950) ; Jarvie Fellowship Medal (Dent. Soc. State of
N. Y. 1951) ; Lasker Award (APIIA, 1952) ; Georgetown Univ., Sch. Dent. Award
•of Merit, 1953; Distinguished Service Award, Am. Assn. Pub. Health Dentists,
1953; Hon. Mem., Sect. Odont., Royal Soc. Med. (London) 1952; Holme Lect.,
Univ. London Hospital Medical College (1952) ;' 1st Panamerican Dental Con-
gress (Buenos Aires, 1952) ; XI Internal. Dent. Cong. (London, 1952). Hon.
Mem. Finnish Dental Society (Helsinki, 1952). Army Commendation Ribbon,
Victory medal w/one cla.sp (World War I). American Defense Ribbon, American
Theater Ribbon, Victory Ribbon (World War II). J\lem. Mass. Soc, Sons Am.
Rev. : Nat. Assn. of the 0th Inf. Div. ; St. Louis University Alumni Federation.
Club: Army and Navy Country. Author of more than .50 articles in scientific,
pub. health, dental, med., and engineering journals dealing largely with epidemi-
ological studies.
Books: Chapters in Gordon's Dental Science and Dental Art. Chronic En-
demic Dental Fluorosis (mottled enamel) ; Moulton's AAAS Monographs
Fluorine and Dental Health (1. Geographical Distribution of Endemic Dental
Fluorosis (mottled enamel) ; 2. The Investigation of Physiological Effects by
the Epidemiological Method) ; and Dental Caries and Fluorine (1. Some General
278 FLUORIDATION OF WATER
Epidemiological Considerations. 2. Epidemiological Studies in the United;
States) ; Levine et al., Advances in Pediatrics, vol. 2 (Role of Flourine in Pre-
vention and Treatment of Dental Caries) ; Carr's Dentistry, An Agency of Health
Service (N. T. Acad. Med.), (Problems for Investigation and Current Progress) ;
Pelton and Wisan's Dentistry in Public Health (Fluorine: Water-borne Fluorides
and Dental Health).
Roman Catholic, Republican.
Home : 2006 Cleveland Street, Evanston, 111.
Office: American Dental Association, 222 East Superior St., Chicago 11, 111.
Publications of H. Teendley Dean, D. D. S., Relating to FLtroEiNE and Dental
Health as Recoeded in the Periodical Litebatueb
(Chapters in Books Are Shown on pp. 3^ of Curriculum Vitae.)
1933
Dean, H. T. : Distribution of mottled enamel in the United States. Jour. Am.
Dent. Assn., 20: 319-333 (Feb.) 1933. (Read before the Research Section of
the 74th Annual Meeting of the American Dental Association at Buffalo, N. Y^
Sept. 1.5, 1932.)
Sebrell, W. H., Dean, H. T., Elvove, E., and Breaux, R. P. : Changes in the teeth
of white rats given water from a mottled enamel area compared with those
produced by water containing sodium fluoride. Pub. Health Rep., 48 : 437^445^
(Apr. 28) 1933.
Dean, H. T. : Distribution of Mottled Enamel in the United States. Pub. Health
Rep., 48: 703-734 (June 23) 1933.
1934
Dean, H. T. : Classification of Mottled Enamel Diagnosis. Jour. Am. Dent. Assn.,.
21: 1421-1426 (Aug.) 1934.
Dean, H. T., Sebrell, W. H., Breaux, R. P., and Elvove, E. : Effect of Various
Amounts of Sodium Fluoride on the Teeth of White Rats. Pub. Health Rep.,
49: 1075-1081 (Sept. 14) 1934.
1935
Dean, H. T. : Mottled Enamel in Cattle. Pub. Health Rep., 50: 206-210, (Feb.
15) 1935.
Dean, H. T., Dixon, R. M., and Cohen, C. : Mottled Enamel in Texas. Pub. Health-
Rep., 50: 424-442, (Mar. 29) 1935.
Dean, H. T., and Elvove, E. : Studies on the Minimal Threshold of the Dental
Sign of Chronic Endemic Fluorosis (Mottled Enamel). Pub. Health Rep., 50::
1719-1729, (Dec. 6) 1935.
1936
Dean, H. T., and Elvove, E. : Some Epidemiological Aspects of Chronic Endemie
Dental Fuorosis. Am. J. Pub. Health, 26: 567-575 (June) 1936. (Read before
the Epidemiology Section at the 67th Annual Meeting of the American Public
Health Association at Milwaukee, Wis., Oct. 7, 1935.)
Dean, H. T. : Action of Fluorides upon Human Teeth. Sclent. Monthly, 43 : No..
2: 191-192 (Aug.) 1936.
Dean, H. T. : Chronic Endemic Dental Fluorosis (Mottled Enamel). Jour. Am.
Med. Assn., 107 : 1269-1272 (Oct. 17) 1936. (Read before the Preventive Medi-
cine Section at the 87th Annual Session of the American Medical Association,
at Kansas City, Mo., May 15, 1936.)
1937
Dean, H. T. : A Summary of the Epidemiology of Chronic Endemic Dental Fluo-
rosis (Mottled Enamel). Texas Dent. Jour., 55: 86-93 (Mar.) 1937. (Read
before the Public Health Section at the 56th Annual Meeting of the Texas State
Dental Society at Dallas, Tex., Sept. 2, 1936.)
Dean, H. T., and Elvove, E. : Further Studies on the Minimal Threshold of
Chronic Endemic Dental Fluorosis. Pub. Health Rep., 52: 1249-1264 (Sept.
10) 1937.
FLUORIDATION OF WATER 279
1938
Dean, H. T., and Elvove, E. : Facts about Fluorides. Eng. News-Record, 120:
591-594 (Apr. 21) 1938.
Dean, H. T. : La Fluorose Dentaire et Son Origine Hydrique aux Etats-Uuis.
BulL OfE. Inter. d'Hyg. Publique. 30: 1294-1304 (June) 1938.
Dean, H. T. : Endemic Fluorosis and its Relation to Dental Caries. Pub. Health
Rep., 53: 1443-1452 (Aug. 19) 1938.
Dean, H. T., McKay, F. S., and Elvove, E. : Mottled Enamel Survey of Bauxite
(Ark.) Ten Years after a Change in the Common Water Supply. Pub. Health
Rep., 53: 173(>-1748 (Sept. 30) 1938.
Dean, H. T. : Some Characteristics of Endemic Dental Fluorosis (Mottled
Enamel). Southwest Waterworks Jour., 20: 11-12 and 20-21 (Dec.) 1938.
(Read before the Southwest Section of the American Waterworks Assn. at
Oklahoma City, Oklahoma, Oct. 19, 1938.)
1939
Dean, H. T., Elvove, E., and Poston, R. F. : Mottled Enamel in South Dakota,
Pub. Health Rep., 54: 212-228 (Feb. 10, 1939.
Dean, H. T. : Etat Actuel de la Fluorose Dentaire Endeminque Etudes aux Etats-
Unis. Bull. Off. Inter d'Hyg. Publique, 31 : 862-S65 (May) 1939.
Dean, H. T., Jay, P., Arnold, F. A., Jr., McClure, F. J., and Elvove, E. : Domestic
Water and Dental Caries, including certain Epidemiological Aspects of L.
Acidophilus. Pub. Health Rep., 54: 802-888 (May 26) 1939. Reprint No.
2073. (Read before the American Epidemiological Society, April 1939, New
York, N. Y.)
Dean, H. T., and McKay, F. S., and Elvove, E. : Production of Mottled Enamel
Halted by a Change in Common Water Supply. Am. J. Pub. Health, 29 :
590-596 (June) 1939. (Read before the Epidemiology Section of the Ameri-
can Public Health Association at the 67th Annual Meeting in Kansas City,
Mo., Oct. 25, 1938.)
1940
Dean, H. T. : Fluorine, Mottled Enamel and Dental Caries, Critical review,
Jour. Pediatrics, 16: 782-794 (June) 1940. (Read before the meeting of
Region I of the American Academy of Pediatrics, Washington, D. C, Apr.
6, 1940. )
1941
Dean, H. T., Jay, P., Arnold, F. A. Jr., and Elvove, E. : Domestic Water and
Dental Caries. I. A dental caries study, including L. acidophilus estimations,
of a population severely affected by mottled enamel and which for the past
12 years has used a fluoride-free water. Pub. Health Rep., 56: 365-381 (Feb.
28)1941. Reprint No. 2239.
Dean, H. T., Jay. P., Arnold, F. A. Jr., and Elvove, E. : Domestic Water and
Dental Caries. II. A study of 2,832 white children, ages 12-14 years, of S
suburban Chicago communities, including Lactobacillus acidophilus studies
of 1,761 children. Pub. Health Rep., 56: 761-792 (April 11) 1941. Reprint
No. 2260. (Read before the 19th General Meeting of the International Assn.
for Dental Research, March 15, 1941, St. Louis, Mo.)
1942
Arnold, F. A., Jr., Dean, H. T., and Elvove, E. : Domestic Water and Dental
Caries. IV. Effect of Increasing the fluoride content of a common water
supply on the Lactobacillus acidophilus counts of the saliva (preliminary
report) Pub. Health Rep., 57: 773-780 (May 22) 1942. Reprint No. 2381.
Dean, H. T., Arnold, F. A. Jr., and Elvove, E. : Domestic Water and Dental
Caries. V. Additional studies of the relation of fluoride domestic waters to
dental caries experience in 4,425 white children, aged 12 to 14 years, of 13
cities in 4 States. Pub. Health Rep., 57: 1155-1179 (Aug. 7) 1942. Reprint
No. 2394. (Read before the 20th General Meeting of the International Asso-
ciation for Dental Research, March 14, 1942, at New York, N. Y.)
Dean, H. T. : Fluorine and Dental Health. Bull. Am. Assn. Adv. Sci., 1: 47-48
(Aug.) 1942.
280 FLUORIDATION OF WATER
1943
Dean, H. T., and Arnold, F. A. Jr. (Bureau of Public Relations), Endemic Den-
tal Fluorosis or Mottled Enamel. J. Am. Dent. Assn., 30: 1278-1783 (Aug^
1) 1943. See correction, JADA, Oct. 1, 1943, p. 1609.
Dean, H. T. : Domestic Water and Dental Caries. J. Am. Water Works Assn.,.
35: 1161-1186 (Sept.) 1943. (Read before the Cleveland Conference of the-
American Water Works Association, June 17, 1943.)
1944
Dean, H. T. : Post-War Implications of Fluorine and Dental Health — Epidemiolog-
ical Aspects. Am. J. Pub. Health, 34: 133-143, Feb. 1944. (Read before the-
Oral Health Group of the American Public Health Association at the 72d
Annual Meeting in New York, N. Y., October 14, 1943.)
Arnold, F. A. Jr., Dean, H. T., and Singleton, D. E. Jr. : The effect of a single-
topical application of a fluoride solution to the teeth of young males of a
military population. J. Dent. Res., 23 : 155-162, June 1944.
1946
Dean, H. T. : On the Epidemiology of Fluorine and Dental Caries. Bull. N. Car>
Dent. Soc, 30: 123-125, Aug. 1946.
1947
Dean, H. T. : Fluorine and Dental Caries. Am. J. Orthod. and Oral Surgery, 33 r.
49-67, Feb. 1947. (Read before the Third Annual Seminar for the Study and,
Practice of Dental Medicine, Palm Springs, Calif., Oct. 8, 1946.)
1949
Dean, H. T. : Fluorine and Dental Caries. 111. Med. Jour., 95: January 1949„
(Read before the 108th Annual Meeting of the Illinois State Medical Society,.
Chicago, May 10-12, 1948.)
1950
Dean, H. T., Arnold, F. A., Jr., Jay, P. and Knutson, J. W. : Studies on Mass-
Control of Dental Caries Through Fluoridation of the Public Water Supply..
Pub. Health Rep., 65 : 1403-1408, October 27, 1950.
Dean, H. T. : Fluorine and Dental Health. Published in the yearbook "The-
Dental Columbian."
1951
Dean, H. T. : The Advancement of Fluoridation. J. Am. W. W. Assn., Vol. 43,.
No. 1, pp. 17-12, Jan. 1915. (Read at the Annual Conference of the American
Water Works Association, May 24, 1950, Philadelphia, Pa.)
Dean, H. T. : The Partial Control of Dental Caries by Fluoridation of Public
Water Supjilies. .]. of the Alissouri State Dental Assn., Vol. 31, No. 8, Aug.
1951. (Read before the Missouri State Dental Association, St. Louis, Missouri,.
April 3, 1951.)
Dean, H. T. : USPHS Position on Fluoridation of Public Water Supplies. J. Am..
W. W. Assn., 43 : 672-674, Sept. 1951.
1952
Dean, H. T. : Fluoridation : Mass Control for Dental Caries. The Am. J. of Nurs-
ing, Vol. 52 : 210-212, Feb. 1952.
Dean, H. T. : Dental Caries and Fluorine. Bol. Inform, y Compend., April 1952,.
page 16. University of Buenos Aires. (Summary of two addresses given
before the Primer Congreso Universitario Pan Americano de Odontologia,.
May 7-8, 1952, Buenos Aires.)
1953
Dean, H. T. : Fluoridation of Public Water Supplies. Midwest Municipal Util-
ities, — : 5, Jan. -Feb. 1953. (Summary of an address given before the Na-
tional Institute of Municipal Law Oflicers, Dec. 1, 1952, Louisville, Ky.)
FLUORIDATION OF WATER 281
Arnold, F. A., Jr., Dean, H. T., and Knutson, J. W. : Effect of Fluoridated Public
Water Supplies on Dental Caries Prevalence. Pub. Health Rep., (58 : 141-148,
Feb. 1953. Reprint No. 3219.
Dean, H. T. : Some Reflections on the Epidemiology of Fluorine and Dental Health.
Am. J. Pub. Health, Pt. 1, 43 : 704-709, June 1953. (Read before a Joint Ses-
sion of the American School Health Association, the Conference for Health.
Council Work and the Dental Health, Public Health Education, and Public
Health Association at the 80th Annual Meeting in Cleveland, Ohio, October
23, 1952.)
1954
Dean, H. T. : Fluorine in the Control of Dental Caries — Some Aspects of the
Epidemiology of the P'luorine-Dental Caries Relationship. International Den-
tal Jour., 4, 311-377, March 1954.
The Chairman. Any questions, gentlemen?
Mr. Heselton. Dr. Dean, I take it from a brief examination of a,
list of various articles and books which you have published that the
matter of fluoridation has been under active study for some years?
Dr. Dean. Yes.
Mr. Heselton. Can you advise us over what period of time that
would be I
Dr. Dean. There were certain early studies, beginning about 1905^
or 1907, where there were studies, and in particular, the Colorado^
studies, but it was not until about 1931, that the causative eft'ects of
fluorine were discovered and then there was a wnder expansion of the
study in this country, also down in the Argentine Republic and in
North Africa.
The fir.st study, of course, during the first 3 or 4 years after 1931,.
was to try to determine what was a safe amount in a water supply so
as not to produce objectionable mottling of the enamel, and from that
basis, they further expanded into developing up the quantitative
means of measuring dental caries as an index in the population iit
order to see whether more of this would occur.
In the last 10 years, the studies have been very extensive. Dr.
Heyroth, who will testify later, will be able to give you the total num-
ber of references now dealing with fluoride which they recently com-
puted down at the University of Cincinnati.
]\Ir. Heselton. Then you made reference to communities whose
water supply contained fluorides and mentioned 2 or 3. I notice in
appendix D of the statement by Dr. Gale there is a listing of com-
munities under the heading, "Control amounts of fluorides are being
added to the water supplies of the following United States Com-
munities.'''
Do you have any additional list to cover the communities that have
fluorides in their water supply naturally?
Dr. Dean. I can obtain one for the committee without any dif-
ficulty. A few years ago the University of Chicago conducted a
study of that nature. The one I did 10 or 15 years ago is probably
quite obsolete now, but I can get for you this newer report in which
they covered all the States and cities in the United States that con-
tained fluoride in various amounts.
Mr. Heselton. I think that would be helpful for the committee.
Will you do that, then?
Dr. Dean. Yes, sir.
282 FLUORIDATION OF WATER
(The information, when received, will be placed in the committee
files.)
The Chairman. Mr. Hale?
Mr. Hale. Doctor, I wanted to ask one question with reference to
this mottling of the enamel which is produced by an excess of fluorine.
Does that affect the teeth in any other manner? That is to say, does
the mottling cause decay or anything of that kind ?
Dr. Dean. No, they are relatively free of decay. Of course, they
have some, but it is low. But it is very objectionable from an esthetic
standpoint. They represent a defective structure.
In the lower amounts, around 2 parts to a million, it is largely a
lack of calcification of the outer surface, a dull chalky white. If you
get up around 4 or 5 parts to a million, this lack of calcification also
gets into hypoplasia, a sort of defective structure, and you start pick-
ing up a brown stain, which you can see in places like Amarillo and
Lubbock, Tex.
Mr. Hale. I cannot hear you, Doctor.
Dr. Dean. Getting to places like Amarillo or Lubbock or all of
west Texas, where they have these fluorides, they have the moderate
or severe amount characterized by brown stain, which is quite disfig-
uring. There is nothing yon can do for it. It is a permanent disfig-
urement in the enamel. That is due to quite high fluorides which we
think should be removed from the water.
Mr. Hale. Which are natural ?
Dr. Dean. They are natural and they should be removed. They
are too high.
Mr. Hale. If I understand the testimony correctly, one part of
fluoride to one million is safe ?
Dr. Dean. It is quite a safe level. You may have a few white
flecks on them, largely in the back teeth, in a small percentage. To
all practicable purposes it is a very, very safe, satisfactory amount.
Mr. Hale. And that is enough to be effective ?
Dr. Dean. Quite effective in reducing dental caries.
I would like to modify that statement like I did in this talk : When
we get into an area like Arizona, New Mexico, southeast Georgia or
some of the Southeastern States, we have the long, hot summers and
the high mean average temperatures. Probably we would consider
six-tenths of a part to one million about the optimal amount, because
they have increased their intake of water and, of course, increased their
fluorine a little bit. In other words, in southeast Georgia, around
fcix-tenths is just about what you see with about 1 around Chicago, 1
or 1.2.
Mr. Hale. Where do you pass the danger line? Is five parts per
million too much ?
Dr. Dean. I would say a lot lower than that. I would say li^
should not be exceeded. At 1.8 you start picking up a little too much
of this white opacity.
Mr. Hale. You should never get beyond 1.8 ?
Dr. Dean. I would not go that high. I think one is ample.
Mr. Hale. One is ample ?
Dr. Dean. One is pretty close to the right amount under average
conditions.
Mr. Hale. If you go above one you run into a risk factor?
FLUORIDATION OF WATER 283
Dr. Dean. Mjube it is possible if you get into a place like North
Dakota or South Dakota or eastern Montana it might go up to 1.4 or 1.5
which might work like 1 around Chicago, or six-tenths in the South-
east States. Dr. (nilagan of the Public Plealth Service has re-
cently done extensive work on the influence of mean average tempera-
tures and climatological factors on this condition.
Mr. Hale. You would readily agree when artificial fluoridation is
done it has to be done with extreme care and accuracy ?
Dr. Dean. There is no doubt about that.
Mr. Hale. And if it is not done with extreme care and accuracy
then the result may be very unfortunate ?
Dr. Dean. Fortunately, they have extremely accurate machinery for
water treatment. Mr. Harris, wdio is coming down from Grand Rap-
ids, can explain that to you in much better detail. He has been doing
that for 9 years. I think he collects 5 or 6 samplings a day.
I think this machine is accurate to about one-tenth of a part a million.
Mr. Hale. When you have a water supply which comes from a lake
I can understand how you can be extremely accurate in putting the
fluorine in, but as in the case of many cities, when you have water
supply coming from a river, how do you manage the fluoridation ?
Dr. Dean. It depends on the fluorine content of the river and
whether there is a seasonal change. If you have three- or four-tenths
part a million in a river you obviously would only have to add about
five- or six-tenths to bring it up to a part per million.
Mr. Hale. I believe that Washington gets it water supply from the
Potomac River, does it not?
Dr. De^^n. That is correct, sir.
Mr. Hale. I do no know where the intake is, but I assume it is up-
stream. If you inject fluorine into the Potomac, where do you put
it in?
Dr. Dean. At the water plant, with the treatment.
Mr. Hale. At the plant itself ?
Dr. Dean. Right at the plant where you treat the water.
Mr. Hale. I should think you would have an element of danger
there, because the stream flow would fluctuate. I should not think
the percentage of fluorine to water would be constant.
Dr. Dean. You are quite right. Obviously you would have to run
chemical analyses of a river so as to know^ what amount you should put
in. You have about one-tenth of a part to a million, or zero, in the
Potomac, we will say, for Washington.
^ At St. Louis you have about three-tenths in the Missouri. Half of
St. Louis city is on the St. Louis County side. You would not have
to go over about seven-tenths there.
I think you have four- or five-tenths in Omaha, on the same Mis-
souri. Again, you would have to adjust the amount you put in based
upon your chemical analysis.
Mr. Hale. What is the mechanical process of putting fluoride in?
Do they inject it with a syringe ?
Dr. Dean. I think probably what we oudit to do is wait until
tomorrow, when Mr. Harris is here. He is the chief chemist at Grand
Rapids and he has been doing it now for between 9 and 9i/^ years
every day. He can describe in detail just how it is done and what
is the degree of accuracy.
48391—54 19
284 FLUORIDATION OF WATER
Mr. Hale. That is all, Mr. Chairman.
The Chairman. Does Washington have a reservoir or take direct
from the river ?
Dr. Dean. I think they have reservoirs.
The Chairman. I assume that is where it would be put in.
Dr. Dean. There is a representative of the Washington Water De-
partment here, who will probably speak tomorrow. He can give
you the detail of the water distribution system here much better
than I could.
Mr. Heselton. Turning to the alleged dangerous aspects of swal-
lowing fluorine, I assume that it is true, as has been testified, that
fluorides in certain forms would be dangerous to anyone. Would you
agree with that?
Dr. Dean. It all depends on the amount.
Mr. Heselton. Yes.
Dr. Dean. So many things in life are dangerous when you have
an excessive amount.
Mr. Heselton. You say the first effort to place fluoride in water
in this country was in 1945 ?
Dr. Dean. 1945 ; Grand Rapids was January 1945. Newburgh was
May 1945. Brantford, Ontario, was June, 1945. Those are the first
three.
Mr. Heselton. Do you know or have you ever heard of any case
of damage or disease attributable to taking water from those com-
munities i
Dr. Dean. I have heard of none, sir.
Mr. Heselton. I would suppose, without having any medical or
dental training whatsoever, that the tongue or the lining of the mouth
is a very sensitive area, which would be injured by any substance
wliich was not wholesome. Would that not be true?
Dr. De\n. If it were in an excessive amount. We are talking about
an amount that is very, very low.
We have large sections of our country using many times what we
are talking about. You can take the area of West Texas ; start up at
Dalhart on the Oklahoma line, go through Amarillo and Lubbock,
down to Big Springs, an area the size of Pennsylvania, and I do not
know of any water supply that does not have 2 to 6 parts per million.
The whole population has mottled enamel, but it is certainly fluoride
water.
Mr. Heselton. What I have in mind is this : If in those two com-
munities for that period of time no damage appears — I am thinking
as a layman — in the mouths, tongues, throats, or stomachs of those
who have been drinking that water daily for around 9 years, it is
some indication. Probably it should show up in that period of time.
Dr. Dean. That is in the fluoridation areas, where you have one
part per million. In the fluoridation cities where they have one
part per million, I have heard of none. That is the question you are
asking.
Mr. Heselton. That is all.
The Chairman. Any further questions?
Mr. Warrurton. Dr. Dean, I think you appreciate that none of us
on the committee are chemists or basically trained in this matter we
are discussing today. Therefore, we have to rely on our own ability
to reconcile what we hear from both sides.
FLUORIDATION OF WATER 285
This morning Dr. Spira indicated that as a result of his examina-
tions and experiments which he conducted earlier he discovered that
there were fluorine indications in those persons with whom he was ex-
perimenting and further drew the conclusion that the signs and symp-
toms that he discovered indicated that these fluorine indications were
derived from sources other than the drinking water.
In your experience, does the average human being actually receive
fluorine through sources other than drinking water, that is, through
the intaking of food arid so forth in his daily life?
Mr. Dean. Practically all the food we eat has some fluorine in it.
Studies conducted by Dr. Armstrong at Minnesota, who will be down
tomorrow, show^, I think, around two or three-tenths of a milligram
per day in the average diet you eat. He could give you some particu-
lar information on that.
Mr. Warbueton. I see. Am I correct in saying, then, that we can
start out with this factor that as an ordinary matter all of us take in
fluorine in some unknown quantity in our daily life ?
Dr. Dean. Two or three milligrams a day, I think.
Mr. Warburton. In some areas of the country there are also water
I supplies used normally which will also contain fluorine ?
Dr. Dean. Yes, sir.
Mr. Warburton. You further suggest, then, in this fluoridation
program, the injection of a constant amount, or to treat the water sup-
ply with a constant amount of fluorine?
Dr. Dean. No. No. I said : Bring the concentration up to the op-
timal level. You may have a fractional part in the water, and you
bring it up to one. If you have three-tenths, you will only need seven-
tenths. If you have zero you will need one. If you vary from three-
to five-tenths on a seasonal switch you would adjust again, so that
you have no more than one in the water supply.
Mr. Warburton. It is your conclusion, then, that the optimal
amount for tlie particular locality, based upon that which is already
normally in the water supply from natural sources, is still sufficient
to cause no danger, regardless of the amount that we take in normally
from sources other than the water supply?
Dr. Dean. The amount we have been taking in as food is probably
so low as to be relatively of no value in protecting against dental
caries.
Mr. Warburton. Let me ask you this the other way around. It it
of such a low value, together with that which is naturally contained
in the water supply and that which is added to the water supply, that
no danger is created ?
Dr. Dean. No. You would see it in a place like Denver or Aurora,
where they have it naturally, and they still eat the same type of food
that we do.
Mr. Warburton. In your experiments, which you indicate here on
page 4 of your report, you indicate that the studies of the National
Institutes of Health culminated in an examination of 7,257 continuous
resident white children of 21 cities, and you drew from those studies
2 conclusions with respect to the beneficial effect that water treated
naturally or otherwise with fluoride concentration has. In the tests
286 FLUORIDATION OF WATER
were tliei'e any groups which were incorporated in the whole test who
received no benefit?
Dr. Dean. These studies had to do with cities where they contained
the fluoi'ide in various amounts, either under natural conditions or
A\ here it was relatively absent.
Mr. Warburton. I see.
Dr. Dean. This was the evidence upon which we took the next step.
We went through the 7,200 studying this thing quantitatively in de-
tail under natural conditions.
Mr. Warburton. The point I am trying to get at is this — and I am
possibly not getting to it because of my lack of knowledge on this
subject — in any particular city under the conditions under which these
studies were made did you have, for example, 500 children whom you
had examined and who showed a lack of dental caries which could be
attributable to the fact that they had been drinking over whatever the
required period of time was water containing naturally fluorides ; and
were there any children, for example, in that same city in the same
age group wdio had received no benefit, although they had been there
for the same length of time and had been taking the same kind of
water?
Dr. Dean, It is quite probable you would have a few. Any time
you take a large group for any biological study of people, 300 or 400,
there may be some who will still have a fair amount of caries; but
if you stated mathematically the average for the group you would find
it is probably down 50 or 60 or 65 percent. We studied that on the
basis of what you call the multiple attack rates, in which the number
of children who had no caries, the number who had one tooth, the
number who had two teeth, and so forth up to 20 were involved. You
could see quite a marked difference.
You could have the case of a sporadic type, where you may have
had 12 or 15 carious teeth, but it was very unusual; hwere as on the
other side you have quite a distribution.
Mr. Warburton. Let me ask you this : In a study of this type when
you are selecting the group of children to examine and study ovei^'
some extended period of time do you just take a group of children
selected at random ?
Dr. Dean. I will tell you how we did these 21 cities. We took all
12-, 13-, and 14-year-old white children in every seventh, eighth, and
ninth grade in every public school in the community.
Mr. Warburton. So it was comprehensive across the whole com-
munity within those particular limits ?
Dr. Dean. Yes.
Mr. Warburton. Thank you.
The Chairman. Any further questions ?
Mr. Williams. Dr. Dean, have you read the testimony of Dr. Exner ?
Dr. Dean. Yes, sir.
The Chairman. Any further questions of Dr. Dean? We thank
you. Doctor.
Dr. Dean. Thank you, sir.
The Chairman. May I inquire as to the length of time that Dr.
Doty would take to deliver his testimony ?
FLUORIDATION OF WATER 287
Mr. Garvey. About 15 niimitos is prepared for, ]\Ir. C^liairniiUi, ab-
sent questions.
The Chairman. Does Dr. Doty intend to be here tomorrow, or is
he leaving tonight?
Mr. Garvey. He can be here tomorrow.
The Chairman. I would appreciate it, then, if we would be able
to adjourn, because we have some people waiting to see members of the
committee on committee business. We would like to talk to theiru
They have been waiting since an hour ago.
The committee will adjourn until 10 o'clock tomorrow, when the first
witness will be Dr. J. Roy Doty.
(Thereupon, at 4:40 p. m., Wednesday, May 26, 1954. an adjourn-
ment was taken until 10 a. m., Thursday, INIay 27, 1954.)
FLUORIDATION OF WATER
THURSDAY, MAY 27, 1954
House of Representatives,
Committee on Interstate and Foreign Commerce,
Washington^ D. C.
The committee met, at 10 a. m., pursuant to adjournment, in Room
1834, New House OflBce Buildin^r, Hon. Robert Hale presiding.
Mr. Hale. The committee will be in order. We will resume this
morning, hearings on H. R. 2341, to prohibit water fluoridation, and
the first witness is Dr. J. Roy Doty of Chicago, 111. Dr. Doty.
STATEMENT OF DR. J. ROY DOTY, SECRETARY, COUNCIL ON DENTAL
THERAPEUTICS, AMERICAN DENTAL ASSOCIATION, CHICAGO,
ILL.
Dr. Doty. Mr. Chairman and members of the committee. May I
say for the American Dental Association, it wishes to express its appre-
ciation to the Public Health Service representatives for allowing
the American Dental Association's representatives to appear first.
I am J. Roy Doty of Chicago, 111., secretary of the council on dental
therapeutics of the American Dental Association, in wiiich capacity
1 have for several years studied and evaluated the scientific literature
relating to fluoridation of community water supplies as a method of
diminishing the incidence of dental caries. I hold the degree of
bachelor of science from Monmouth College, Monmouth, 111., and
doctor of philosophy from the University of Illinois. From 1928 to
1930 I taught inorganic and analytical chemistry at Monmouth Col-
lege, from 1933 — after obtaining my doctor's degree — to 1935 I did
research on the effect on animals of the ingestion of spray residues on
plant products ; and from 1935 to 1943 I was first instructor and sub-
sequently assistant professor of physiology at Louisiana State Uni-
versity School of Medicine at New Orleans. Since 1943 I have been
associated with the council on dental therapeutics of the American
Dental Association.
My purpose in appearing before you today is to discuss some of
the biochemical aspects of community water fluoridation programs.
The fluoridation of drinking water is a simple, natural, and straight-
forward procedure for insuring to millions of children the opportunity
to obtain the optimum amount of an important trace element in nutri-
tion. During the period of tooth development it is essential that chil-
dren receive adequate but limited amounts of fluoride in order that
their teeth may become more resistant to those forces which lead to
tooth decay and its resultant potential for further ill healh.
289
290 FLUORIDATION OF WATER
Nearly 4 million United States residents receive Avater which for
many years has carried adequate or even excessive amounts of fluoride
as an incidental constituent. An additional 17 million Americans
currently receive water whose fluoride content is adjusted to a desir-
able level. Fluoride is a trace element in nutrition and water is a
natural source of this nutritional element. There are compelling rea-
sons why this dietary fluoride should be available in drinkino; water.
The individual's consumption of water is more uniform than the con-
sumption of any other one food. Water is. in fact, the only vehicle for
dietary fluoride whose adequacy and safety has been demonstrated
by extensive experience. Other considerations of safety, convenience,
and economy contribute to the same conclusion. Hence, only con-
fusion and possible hazard could result from the use for this purpose
of other foods containing added fluoride.
At this point I wish to emphasize certain fundamental chemical
concepts which bear upon the subject of fluoridation. Some opponents
of purposeful fluoridation have alleged that tlie fluoride which is
added in an incidental manner to water when it passes through certain
fluoride-bearing strata of the earth is somehow different from the
fluoride which is added at a Avater treatment plant. To the chemist,
the following concepts are axiomatic :
1. All fluorine is natural fluorine.
2. To determine if fluoride is present in water, whether there nat-
urally or purposefully added, the chemical procedures employed seek
in either case to determine the fluoride ion concentration.
The chemist, therefore, is led to the inescapable conclusion that
fluoride ions are identical whether they are derived from calcium
fluoride, sodium fluoride, or some other salt which dissociates to form
fluoride ions in water solution. Biological observations give added
confirmation to this concept, which is so fundamental to our considera-
tion that the association has asked that statements be sent to your
committee by other chemists whose competence is recognized through-
out the chemical profession. We hope that these will be made a part
of this record.
These chemists include the following and others :
Dr. Farrington Daniels, president in 1953 of the American Chemical
Society ; a member of the National Academy of Sciences ; and chair-
man of the department of chemistry at the University of Wisconsin.
He is a recognized authority in the field of inorganic and physical
chemistry.
Dr. Henry S. Frank, professor of chemistry and head of the depart-
ment of chemistry at the University of Pittsburgh, who has sent
the chairman a letter dated May 18. 1954, which he has requested be
made part of the record.
Dr. John C. Bailar, professor of chemistry and director of the
division of inorganic chemistry in the department of chemistry at
the University of Illinois.
Due consideration of the statements of these chemists of recognized
competence and integrity should dispel the confusion caused by the
pseudoscientific and careless assertions regarding the chemistry of
fluorides made by some of the opponents of municipal water fluorida-
tion.
I also wish to interpolate at this point to say regardmg some pre-
vious testimony by Dr. Brusch and others that in my opinion no
FLUORIDATION OF WATER 291
competent chemist would refer to calcium fluoride as an oroanic
fluoride. Calcium fluoride is, in fact, a typical example of an inor-
ganic fluoride salt. Even in its crystal form, that is, as a solid, it
exists as calcium ions and fluoride ions in a geometrical arrangement
within the crystal. When the crystal dissolves in water, the ions are
dissociated in the sense that they no longer retain any fixed position
with respect to each other but become distributed throughout the
solution and the calcium ions are totally indistinguishable from all
calcium ions from any other source and similarly the fluoride ions
are indistinguishable from fluoride ions from other fluoride salts.
I should state further that the relative solubilities of calcium fluoride
and sodium fluoride have no pertinence to this hearing. In order to
obtain a 4-percent solution of sodium fluoride one must add 40 grams —
40,000 milligrams — of sodium fluoride to each 1,000 cc of water. This
is approximately 20,000 times the concentration of sodium fluoride
employed in a controlled fluoridation procedure. Similarly, a solu-
tion of IG milligrams of calcium fluoride in 1,000 cc of water would
provide a concentration of fluoride ion of about eight times that
involved in a community fluoridation program. It is apparent there-
fore that the relative solubilities of the two salts have no significance
in the matter of drinking water fluoridation.
In the United States, fluoride is found in large deposits particularly
associated with rock phosphate. This material is mined and the flu-
oride is recovered by chemical transformation into its several salts,
some of which are employed for water supplementation. We may
therefore describe the fluoridation program as a procedure in which a
natural substance is shipped from an area of abundant production into
an area of deficiency. Fundamentally, the principle is no different
from the production and distribution of other foods.
Another point which warrants emphasis is the fact that a nutri-
tional substance which may be recpiired in small quantities to main-
tain life, may on the other hand be seriously toxic if it is consumed in
large amounts and in a concentrated form.
Vitamin A is a classical example of such a nutrient. The Food and
Nutrition Board of the Xational Research Council recommends a
daily dietary allowance of about i^ to li/^ milligrams of this nutrient.
This quantity may be obtained from several wholesome foods. Vita-
min A is also available in highly concentrated forms which through
accidental misuse have led to a serious poisoning. This fact is Avell
known to nutritionists and to pediatricians and other physicians and
it has been the subject of editorial comment in the Journal of the
American Medical Association (1) . It should be noted that the toxic
effects were observed onl}- when the quantities consumed were in the
range of one hundred times or more greater than the recommended
allowance.
A fairly close analogy exists betAveen the amounts of vitamin A
and the amounts of fluoride ion which are beneficial and also the
amounts which may cause injury. When persons use a drinking water
containing one part per million fluoride ion, their daily intake of this
nutrient may range from a fraction of a milligram in the case of
infants up to about one and one-half to two milligrams in the case of
adults. These quantities correspond closely to the recommended
amounts of vitamin A. W^e can extend this analogy by another illus-
292 FLUORIDATION OF WATER
tration. To obtain toxic amounts of vitamin A from oleomargarine
fortified at the usual level of 414 milligrams per pound of food would
require the daily consumption of some 15 to 40 pounds of this food.
Similarly, it would be impossible to drink sufficient water contain-
ing fluoride ion at a level of 1 part per million to produce a toxic
effect attributed to fluoride. It would be necessary to drink 50 to 100
gallons of such water at one time in order to ingest a possible lethal
dose of fluoride. Any such attempt would obviously lead to death
by "water poisoning" before symptoms of fluoride poisoning were
observed. The basic purpose of this analogy, however, is simply to
emphasize the fact that the recognized toxicity of relatively large
amounts of fluoride is not in itself any indication of lack of safety of
the very small amounts associated with fluoridated water.
Before discussing the specific evidence which relates to the safety
of fluoridation, it will be well to outline briefly the general areas from
which this information is derived.
I. OBSERVATIONS WITH ANIMALS
a. Accidental exposure of animals to forage contaminated with
fluoride-bearing dust.
b. Exposure of animals to fluoride through the attempt to employ
fluoride-containing rock phosphate as a substitute for other forms of
calcium phosphate in feeds.
c. Experimental studies involving thp administration of inorganic
fluoride to a variety of animal species.
II. OBSERVATIONS ON HUMANS
a. Workers unwittingly subjected to industrial exposures to fluo-
rides.
b. Individuals exposed to single large amounts of fluoride through
accident.
c. Studies with volunteers receiving known amount of fluoride.
d. Individuals who for many years have used drinking water con-
taining from 1 to 14 parts per million of fluoride ion.
e. Observations for periods up to 8 years in pilot fluoridation studies.
By way of indication of the quanitity of data available, it may be
noted that the following publication contains a listing of more than
five thousand separate reports : the title of this article is "Classified
Bibliography of Publications Concerning Flourine and Its Com-
pounds in Kelation to Man, Animals, and Their Environment Includ-
ing Effects on Plants" from the Kettering Laboratory in the Depart-
ment of Preventive Medicine and Industrial Health, College of Medi-
cine, University of Cincinnati, Cincinnati, Ohio.
Since any careful evaluation of the safety of fluoridation requires
the detailed study of several hundred comprehensive original reports,
many individuals will prefer to rely upon the conclusions of agencies
of recognized competence in the biological and medical field. Two
reviews of special significance are the report of the Ad Hoc Commit-
tee on Fluoridation of Water Supplies (2) of the National Research
Council, and the report of the Council on Pharmacy and Chemistry
of the American Medical Association (3). Both of these committees
FLUORIDATION OF WATER 293
reviewed the evidence and concluded that the use of drinking Avater
containing 1 part per million of fluoride ion is safe.
A very recent report on water fluoridation prepared by a committee
of the St. Louis Medical Society (5) has been filed with your commit-
tee. This group concluded that "No other public health measure has
had more thorough study prior to adoption than the proposal for fluo-
ridation of the community water supply whose natural concentration
of fluorine is deficient."
By way of summary of the physiological effects of fluoride, it may
be pointed out that the most sensitive indicator of excessive intake of
fluoride is the appearance of mottling of the enamel when fluoride is
ingested during the developmental period of the teeth. Objectionable
mottling of the teeth does not occur with controlled fluoridation (6)
but noticeable mottling occurs when the fluoride content of water is
several times the concentration required for the dental benefits. Ab-
sence of mottled enamel is therefore a demonstration that the fluoride
level is too low to permit other detectable adverse physiological effects.
Next in the order of sensitivity to excessive exposure to fluoride are
bone changes. Impairment of bone function has never been detected
in this country as a result of exposure to fluoride in drinking water
even after long continued use of water containing up to 14 parts per
million of fluoride ion. Changes have been observed, however, in the
case of a few workmen exposed over many years to very large amounts
of fluorides as dust or vapors. Post-mortem analyses have been re-
ported for two such individuals who died of disease not related to
fluoride (7). They were exposed over a period of about 20 years to
an estimated daily intake of 15 to 25 milligrams of fluoride. The
bones of one individual contained 50,000 milligrams and those of the
other, 90,000 milligrams of fluoride. It may be noted that the lower
of the two figures is about the total amount which would be ingested
by daily use of drinking water containing 1 part per million of fluoride
ion consumed over a period of 125 years. Since the major portion of
ingested fluoride, up to levels of 4 to 5 parts per million, is eliminated
in the urine, (8) it is obvious that use of fluoridated water could never
lead to the skeletal levels observed in these individuals with high in-
dustrial exposure to fluoride. These bone studies do emphasize, how-
ever, that even when the body takes in fluorides beyond the capacity
of the kidneys immediately to excrete the excess, nature has provided
a safety mechanism through the remarkable ability of the human skele-
ton to absorb and retain the excess.
An exposure greater than that just described is necessary to produce
changes in the soft tissues of the body. Effects upon the kidneys and
other non-skeletal tissues have not been observed in animal experi-
ments until quantities or concentrations in the neighborhood of 100
to 500 times those involved in water fluoridation are administered.
For example, effects upon the kidneys have been noted in dogs when
they received 5 to 8 milligrams of fluorine per kilogram of body weight
per day (7). By way of contrast, it should be noted that the average
adult, in order to ingest this relative amount of fluoride, would have
to drink 80 to 100 gallons of water containing 1 part per million of
fluoride ion each day.
A pertinent consideration in assessing the safety of fluoridation is
the remarkable fact that the crucial demonstration was obtained
294 FLUORIDATION OF WATER
Ihrougli long-term exposure of liumans to high levels of fluoride in-
take in drinking water. The scientific advantage of measuring the*
effect directly on humans is evident. In assessing the safety of any
substance, it is highly desirable also to know its effect when admin-
istered for long periods of time and at levels many times those which
will be used under controlled conditions. All of these conditions were
provided not by human intent, but by a circumstance of nature. Ap-
proximately 4 million people in the United States have, for many
years, used drinking water containing fluoride ion at a concentration
from 0.7 to 3 parts per million or more (9). In Texas alone, oyer
60,000 individuals used water containing from 3 to 5 parts per million
of fluoride ion (10). Special studies, including the use of X-rays,
were made in Bartlett, Tex., (11) where the water contains 8 parts per
million of fluorine. No evidence of injury other than mottled enamel
was observed.
I understand, by way of interpolation, that some additional evi-
dence is available of further studies of Bartlett, Tex., and I think that
those will be made available to the committee. There was no func-
tional impairment of the bones and even the X-rays revealed only
questionable evidence of increased bone density in 11 percent of those
examined. One of the highest exposures to fluoride in drinking water
occurred in Bauxite, Ark., where after many years of use it was found
that the well water contained approximately 14 parts per million of
fluoride ion. -
Many additional studies have been reported from areas where the
drinking water contains at least 1 part per million of fluoride ion.
These reports include studies of excretion, (8), (8a), (8b), bone frac-
ture experience and height and weight studies (12), and careful ex-
amination of vital statistics data (13). The results of all of these
studies have resulted in the conclusion that controlled fluoridation
presents no hazards to health.
In spite of the mass of evidence relating to safety of fluoridation
which was available before pilot fluoridation projects were initiated,
it still seemed desirable to include medical examinations as a part of
some of these studies. The results of 6 years of water fluoridation
have been reported for the Newburg study (6). The pediatric ex-
aminations which are a part of this study have revealed no abnoi-mali-
ties which can be attributed to the added fluoride. Seven years' obser-
vation of fluoridation in the Southbury Training School, Southbury,
Conn., have failed to reveal any evidence of injury to middle aged and
elderly inmates or employees. The studies have included frequent
X-rays of the skeleton on a large number of these people; urinary
studies; blood counts and smear examinations; and occasional studies
of liver function ( 14) .
A remarkable observation is the low level of fluoride reported in
the blood of individuals using fluoridated drinking water ( 15) , When
using a drinking water containing about 1.2 to 1.3 parts per million
of fluorine, the average blood fluoride concentration was only 0.04
part per million and the highest observed value was only 0.09 part
per million. These data emphasize the remarkable effect of fluoride
deposition in bone and of kidney excretion in preventing the accumula-
tion of fluoride in the blood.
This statement can provide only the briefest outline of some of the
pertinent considerations relating to the safety of fluoridation. As
FLUORIDATION OF WATER 295
PiOted earlier, there are hundreds of published articles which bear upon
this point. The information included here emphasizes the fact that
damage to soft tissues occurs only at such hioh levels of intake as to be
of no concern in water fluoridation. If further emphasizes the remark-
able ability of the body to excrete fluoride under normal conditions
and to sequester and store fluoride in the bones under unusual con-
ditions.
In conclusion, it should be remembered that over a period of many
years extensive and numerous surveys and studies have failed to reveal
any hazard to health from the ingestion of drinking water containing
fluoride ion in concentration of 1 part per million.
(The bibliography referred to is as follows :)
Bibliography
1. J. A. M. A. 143 :1417 Aug. 19, 1950 (editorial).
2. National Research Council. Report of the Ad Hoc Committee on Fluorida-
tion of Water Supplies.
3. American Medical Association, Council on Pharmacy and Chemistry and
Council on Foods and Nutrition. Fluoridation of water supplies. J. A. M. A
147 :1359, Dec. 1, 1951.
4. Heyroth, F. F. Toxicological evidence for the safety of the fluoridation
of public water supplies. A. J. Public Health 42 :1568, Dec. 1952.
5. Report of Committee of the St. Louis Medical Society. Missouri Medi-
cine, Feb. 1954, p. 124-142.
6. Ast, D. B., and Chase, Helen C. The Newburgh-Kingston caries fluorine
study. IV. Dental findings after six years of water fluoridation. Oral Surg.,
Oral Med. & Oral Path. 6 -.114, Jan. 1953.
7. Roholm, K. Fluorine intoxication. London : H. K. Lewis & Co., Ltd.,
1937. Cited by Heyroth, F. F. Toxicological evidence for the safety of the
fluoridation of public water supplies. A. J. Pub. Health 42 :1568, Dec. 1952.
8. McClure, F. J., and Kinser, C. A. 1944. Fluoride domestic waters and
systemic effect. II. Fluorine content of urine in relation to fluorine in drinking
water. Pub. Health Reports, 59 : 1575.
8a. Machle, W. ; Scott, E., and Treon, J. Normal urinary fluorine excretion
and the fluorine content of food and water. A. J. Hygiene, 29 :139, 1939.
8b. Largent, E. J. Rates of elimination of fluoride stored in the tissues of
man. Archives of Industrial Hygiene & Occupational Medicine, 6 : 37, July 1952.
9. Task Group E5-10, Committee on Fluoridation Materials and Methods,
American Water Works Association. Natural and applied fluoridation census.
J. A. W. W. A. 44 :.553, June 1952.
10. Hill, I. N., Jelinek, O. E., and Blayney, J. R. The Evanston dental caries
study. III. A preliminary study of the distribution of fluorine in communal
water supplies in the United States. J. D. Res. 28 :398, Aug. 1949.
11. Testimony of Dr. Francis A. Arnold, Jr. Hearings Before the House
Select Committee to Investigate the Use of Chemicals in Foods and Cosmetics.
H. Rep 82d Cong., 2d Sess., pursuant H. Res. 74 and H. Res. 447, P. 3, 1655.
12. McClure, F. J. 1944. Fluoride domestic waters and systemic effects. I.
Relation to bone fracture experience, height and weight of high school boys
and young selectees of the armed forces of the United States. Pub. Health
Reports, 59 :1543.
13. State of Illinois, Department of Public Health, Bureau of Statistics.
Mortality in fluoride and non-fluoride areas. Special release No. 20, April 1,
1952.
14. Letter to Dr. L. F. Menczer, Department of Health. Hartford, Conn., from
the Southbury Training School, Southbury, Conn., signed by Herman Yannet,
M. D., medical director, October 1, 1952.
15. Smith, Frank A., Gardner, Dwight E., and Hodge, Harold C. Investiga-
tions on the metabolism of fluoride. II. Fluoride content of blood and urine as
a function of the fluorine in drinking water. J. D. Res. 29 :596, Oct. 1950.
Mr. Hale. Thank vou. Dr. Doty. Are there any questions ?
Mr. Pelly. Mr. Chairman.
Mr. Hale. Mr. Pelly.
296 FLUORIDATION OF WATER
Mr. Pelly. I would like to ask the witness if fluorides disappear
in the boiling of water or if it becomes more concentrated due to the
evaporation ?
Dr. Doty. One would naturally presume that to the extent that
water is concentrated by evaporation, that the fluoride content would
increase to that extent.
May I supplement that, however, by saying that in all of the expe-
rience which we have had that has been taking place — in other words,
the millions of people who have been using fluoride-bearing water
have been doing exactly that, and it is probable that that is one of
the factors which leads to the intake of that quantity which is dis-
soluble. In other words, the determination of the quantity that is
dissoluble was not obtained by finding the actual amount that was
ingested each day by the individual. It was absorbed by seeing the
concentration in the water that was used for all of these people —
drinking, cooking, in cooking of foods; goes into the preparation of
canned food, and processing of foods and juices and every other way
that an individual normally employs, and- the drinking of water,
and under all of that set of conditions. It was observed that a level
of about 1 part per million in the water to begin with was the concen-
tration which was both safe and dissoluble.
Mr. Pelly. In bathing, the body absorbs considerable water, does
it not?
Dr. Doty. There is no evidence to that effect, no.
Mr. Pelly. There is not?
Dr. Doty. No. The transfer of water across the skin is negligible.
Mr. Pelly. I always thought you weighed more after you took a
bath than before.
Dr. Doty. I do not think that would be true, after drying yourself.
Mr. Pelly. I gather from your testimony that 1 part per million
of fluoride in water is not the actual amount that one gets, but because
of cooking, that you actually get a concentrated form, so that you are
tretting more than that, and that is considered by you as a safe leveH
Dr. Doty. That is correct. We have to distinguish between the
concentration, which means a given amount in a given volume and
between the amount which means the total ingested, irrespective of
the volume that is involved; and the intake of water by anv indi-
vidual will involve that which he drinks directly, that w4iich he
consumes with food processed in the water; beverages made using
boiling water, and so on, so that the over-all measure of the eflect is
made under actual conditions of use.
Mr Pelly. Well, is it not true that m warm climates, or warm
seasons, that an individual absorbs a great deal more water than he
does in periods of cool weather or in cool climates ?
Dr Doty. That is probably true, and if I may extend my remarks a
little bit in that regard, I would point out that that is one of the rea-
sons why it is not recommended that the same concentration; the
same level of fluoride be employed in water in such hot climates.
May I point out further, however, that there are a number of addi-
tional factors which would be considered in thinking of the safety
of its use under those conditions. .
In the first place, an individual who is drinking a large q/^jantity
of water under those conditions is perspiring freely, probably, it
has been shown that there is excretion of fluorides m the sweat.
FLUORIDATION OF WATER 297
Secondly, those individuals who drink large amounts of water are
excretino; large volumes of urine and as it has been shown, that even
up to the level of 4 to 5 parts fluoride in the water, a large proportion
of that ingested, fluorides is excreted in the urine.
So that there are many safety factors ; many details of physiologi-
<^1 aspects which bear upon that particular subject.
Mr. Pellt, Have any experiments been made with regard to using
the chemical, if it is called a chemical, as fertilizer for plant life ; and
how it affects say the tomatoes, or juice of tomatoes that one would
drink, or orange juice? Would that include fluorides, if the fluorides
were placed in the soil?
Dr. Doty. There is no significant increase in the content of fluorides
in ordinary plant products. Some of the types of products to which
you refer would tend to dilute one's intake of water, because the large
amount of water in those articles would tend to dilute the intake of
fluorides, rather than to increase it.
Mr. Pellt. The Florida delegation used to provide the Members
of Congress with free orange juice all of the time, and they have done
away with that custom — I am sorry to say.
I think we can all feel then very safe, if we do drink lots of orange
juice, and milk, and tomato juice. I know that Mr. Beamer, a mem-
ber of our connnittee, is constantly sending out little cans of tomato
juice, which we enjoy very much.
Dr. Doty. I would regard those all as wholesome foods.
Mr. Felly. Some of the visitors who are here in Washington in
connection with this hearing, who do not enjoy the Washington
water — will not take it — can feel safe then if they drink orange juice
and other canned juices that are available.
I think that .does not solve the problem of bathing.
That is all, Mr. Chairman.
Mr. Priest. Mr. Chairman.
Mr. Hale. Mr. Priest.
Mr. Priest. Mr. Chairman, I had 1 or 2 questions I wanted to
ask.
Dr. Doty, we have had testimony before the committee on yesterday
or the day before, the conclusions of which, without fully going into
it, were that there is a difference between the fluoride naturally in
water and that purposely added to water.
I gather from your testimony, that from the chemist's viewpoint
that the ions — I believe you call them — are identical, whether they
come from calcium fluoride, or sodium fluoride, or whatever source
they may come from.
Dr. Doty. That is correct.
Mr. Priest. Is that a pretty generally accepted view in the chemical
field?
Dr. Doty. That is practically a unanimous view.
Mr. Priest. You reported also in connection with your discussion
of that point, that several chemists, very eminent chemists, have made
reports on this.
Dr. Doty. That is right.
Mr. Priest. May I ask, Mr. Chairman, that those that have been
referred to, the ones that he referred to, which may not yet have been
received, be made available. I certainly hope that we will get them
298 FLUORIDATION OF WATER
and that there will be a follow up to be certain that they are received
by the committee.
Now, just one other question, and I do not want to prolong this dis-
cussion.
On page 2, you made this statement :
Fluoride is a "trace element in nutrition" and water is a natural source
of this nutritional element.
Will you just very briefly break that phrase down into a layman's
language.
Dr. Doty. Yes. It means just exactly what it says. "The trace
element" means one which ingested in a very small quantity, is con-
sidered a trace; an element, of course, in nutrition means that it is
a factor important in nutrition. The reason that was put in quotes
was that is practically the language used in the Ad Hoc Committee
report of the National Research Council.
Mr. Priest. Thank you. Doctor. That is all, Mr. Chairman.
Mr. Heselton. Mr. Chairman.
Mr. Hale. Mr. Heselton.
Mr. Heselton. Doctor, I regret that I was unable to get here in
time to hear all of your statement.
I would like to inquire whether you have discussed the effect and
determined the effect on people beyond cJiildhood ; that is, upon peo-
ple who are over the period of time that has been suggested do bene-
fit by taking fluorides in any form ?
Dr. Doty. That was discussed only incidental in my formal pres-
entation here.
It is included in the vital statistics. In other words, the measure-
ments in various population groups of the amount of different types
and degrees, which will include the aged as well as the young, and to
that extent my reference here to vital statistical data do apply to
such individuals.
I may say there is further additional reference both to the dental
benefits to children and to the adult, and with respect to the safety to
the adult.
One further point I referred to here in tliat connection was the
experience of the Southbury Training School in Connecticut, where
they have had fluoride-bearing water, used that for a number of
yeaVs, and where it has been used by both the inmates and the
employees. In that institution there are some who are quite elderly,
and in very extensive medical examination of most of those individuals
they found no evidence of injury to those particular individuals.
With reference to the dental benefits, the dental benefits which
are obtained and are obtained during the period of childhood, that
is, while the teeth are developing, are retained into adult life. There
have been studies made, comparing 40-year-olds, for example, who
have lived their entire life in Colorado Springs, drinking Colorado
Springs water, where the water contains about two and one-half parts
fluorides; comparing those 40-year-olds, that is their mouth condi-
tions, with those of 40-year-olds in Boulder, Colo., where the water
contains a very low percentage of fluorides.
Now, it has been found that the same ratio of benefits, dental bene-
fits, observed in children is still observed in those adults and that
FLUORIDATION OF WATER 299
those adults who have lived in that fluoride area, that is, Colorado
Springs area, have retained a larger number of teeth than have the
individuals who lived in the area without fluoride. There have been
rather extensive studies with adults.
Mr. Heselton. You have anticipated the second question I wanted
to ask you.
My attention has been called — first, were you here yesterday ?
Dr. Doty. Part of the time ; yes.
Mr. Heselton. Did you hear Dr. Dean testify ?
Dr. Doty. Yes.
Mr. Heselton. My attention has been called to the fact that he
testified as to the prophylactic effect of fluoridation up to the age of
9 years only while there has been other testimony, 1 am told, that
would show that the number of decayed teeth, in both Newburgh,
N. Y., and Grand liapids, Mich., among the individuals of the age
14 exceed that in connnunities where there was no fluoridation.
"Would you comment on that ?
Dr. Doty. Yes, I would be very happy to.
You are correct, of course, in saying that he testified with regard
to children up to the age of 9 in those areas where fluoride is merely
being added, because that is the maxinnun length of time that it has
been added in a given connnunity. However, Dr. Dean also testified
with respect to very extensive studies which he and his colleagues
made some years prior to that in which they observed primary 12-
and 14-year-old children who had lived their entire lifetime in an
area where the water, incidentally, contained fluorides. So actually
he testified both with respect to children up to 9 years of age, and
with respect to children at an older age.
Now, what Dr. Dean pointed out was that, of course, where fluoride
has been purposely added for a period of 5 years, you can only com-
pare that then with 5-year-olds; in a community where it has been
present all of the time, you see, because only the 5-year-old children
in this one community will have used it for 5 years.
The lO-year-old children have only used it during the last 5 years
of their lives.
Now, whenever fluoride has been added for a period of 9 years,
there will be children up to 9 years of age who will have used that
water throughout their entire lifetime. The 10-year-old age group
and the 12-year-old age group would only have used it during the
last 9 years of their lifetime.
Now, when you compare then the a]:)propriate age group in a cit}'
which is receiving controlled fluoridation, with that age group in the
area where the fluoridation has been there, as I say, incidentally, you
find identical results; but obviously it is not possible to compare 12-
and 14-year-olds in Grand Rapids, for example, with 12- and 14-year-
olds in Aurora, 111., for the reason that the Grand Rapids experiment
has not been proceeding for 12 to 14 years.
Mr. Heselton. You say that those studies have been made ?
Dr. Doty. Yes, sir.
Mr. Heselton. What conclusions were reached ?
Dr. Doty. You mean from the studies in those areas where tlie
water incidentally contains fluorides?
Mr. Heselton. In comparison with the others.
48391—54 20
300 FLUORIDATION OF WATER
Dr. Doty. In comparison with the others. They have found that
the results, when they compared those age p:roups or those children
who had received the water throughout their entire lifetime, were the
same.
Mr. Heselton. In your annotations, have you made reference to
those studies ?
Dr. Doty. Those studies will be referred to in Dr. Dean's report.
It is referred to in there.
Mr. Pelly. Mr. Chairman, may I ask another question ? I believe
the gentleman has yielded the floor ?
Mr. Hale. Mr. Pelly.
Mr. Pelly. Doctor, is it true that fluorine, so far as certain indus-
tries are concerned, contaminates the water so that it causes gi-eat
damage, almost put certain industries out of business. Is that not
true '( We had a query on that. We have to have pure water for paper
manufacturers, for instance.
Dr. Doty. I am not sure that I know the direction of your question.
I think, however, that it relates to whether or not there is an ill effect
on industrial use of the water.
Mr. Pelly. Discoloration of paper, and other products that are
manufactured.
Dr. Doty. May I comment in that regard, that that was one of the
things that was given early consideration before any pilot study proj-
ect was inaugurated, and there has been no evidence that the use of
water containing 1 part per million fluoride has an adverse eft'ect or
adversely ati'ects any industrial processes.
I may say for example, that many industries have for years used
water containing considerable more fluoride than this particular
amount. As a matter of fact, there was a public statement of one of
the large breweries of St. Louis just a short time ago saying that they
had no objections to controlled fluoridation of the St. Louis water
supply.
Another industry, or other industries have anticipated this problem.
The baking industry some years ago investigated the possible efi^ect of
fluoride upon the use of yeast and other products in the baking of
breads. Other industries have also anticipated the same problem.
They wanted to assure themselves that the use of this water would not
complicate their procedures.
A very extensive review of that consideration appeared in the Jour-
nal of the American Waterworks Association about, I believe, 6 months
or a year ago.
We know of no industry which will be handicapped by the use of
this water.
Mr. Pelly. Thank you.
I would like to ask you as to whether or not it is possible to put
fluorine into milk, for example, so that it would be possible for those
who, on religious basis, could order either fluorine-free milk, or those
that wanted fluorine and where it was recommended by their dentists,
could buy it if they wanted to and not impose it upon all of the people
who have objected to it.
Dr. Doty. May I be permitted to comment rather extensively on
that point ? I will be very happy to do so.
Mr. Pelly. I think it should be in the record, Mr. Chairman.
FLUORIDATION OF WATER 301
Dr. Doty. I will be glad to do it.
Let me say fir^^t that extensive consideration has been given to the
possibility of adding fluoride to one or a number of food products.
Now, one of the particular points that I made in the early part of
my statement was the fact that water is the only vehicle whicli has
been demonstrated to be a safe method of j^rovidin^ dietary fluoride.
If that were not true, it would be possible to add fuioride, to supple-
ment other materials with fluoride, and allow people to obtain it in
that particular way.
I would like to point out that the quantity of fluoride required by
the child — he must receive a certain amount in order to receive the
benefits — he should not receive an excessive amount in order to elimi-
nate the possibility of unesthetic effect of the mottling of the teeth.
Consequently, the amount which the individual obtains must be kept
within fairly narrow limits.
There is quite a margin of safety, but still it must be kept Avithin
fairly narrow limits.
Now, the amount of water which an individual ingests is more nearly
constant each day than any other single food element. That is one
factor to be considered.
A second factor to be considered is that we simply do not know
whether fluoride added to milk with have the same beneficial effect
which will be attained from fluoride in the water.
Now, there are certain theoretical chemical reasons for anticipating
difficulties there.
That is due to the fundamental fact, that we simply have no dem-
onstration that this addition of fluoride at the same level to milk will
produce the same dental benefits which will be produced, or Avhich
are always observed, when fluoride is added to water in this particular
concentration.
Now, may I also comment on the subject of so-called mass
medication ?
I think obviously, for example, when you are enacting legislation
you have to accept a certain definition in order that you can enact
legislation which applies just to a particular thing and not to every-
thing else. .
So, we must also arrive at some sort of a commonsense definition
of medication.
Now, when a doctor prescribes for you some drug or material to be
used in the treatment of a specific disease, I think we would all agree
that that is medication. In other words, when I drink orange juice
to obtain vitamin C, or when you do, you are in effect using a material
to prevent the development of a disease, because a lack of vitamin A
may lead to a condition which in the gross symptom is referred to as
scurvy, and so the drinking of orange juice then is the taking in of
material which prevents the development of a disease.
When a child drinks milk or other food, which contains vitamin D,
that child is being protected by the ingestion of that food material
from the development of a disease which in its gross form is known as
rickets.
"Wlien individuals eat ordinary food containing vitamin Bl, they are
preventing the development of a disease which in its gross manifesta-
tion is referred to as beriberi. So that you can say that every nutri-
ent which is required by the body is for preventing disease.
302 FLUORIDATION OF WATER
Now, if you wish to extend the definition of medication to every
food which is ingested, then I am perfectly safe in saying that that is
medication; but if you wish to accept a definition for medication
which exckides the ingestion or nutrient materials, for the benefit
which they provide to the body, then you must, of necessity, exclude
fluoridation from the concept of medication.
Mr. Rogers. Mr. Chairman. Will the gentleman yield?
Mr. Felly. I will yield to the gentleman.
Mr. Rogers. I am glad you referred to orange juice, because
I come from the State of Florida and I am glad to hear you say that
milk and orange juice are safe.
Mr. Felly. I am sorry that the gentleman from Florida was not
here earlier, because I have already referred to the benefit of orange
juice and expressed a disappointment that we do not still have the
orange juice dispensed to us regularly by the delegation from Florida.
Mr. Hale. As there any further questions ?
Mr. Heselton. Mr. Chairman.
Mr. Hale. Mr. Heselton.
Mr. Heselton. Doctor, in connection with your bibliography, also
Dr. Dean's ; and some other witnesses who have testified, may I inquire
whether copies of each of these articles to which references have been
made are available to the committee ?
Dr. Doty. Some of them have been made available, but not all of
them. In the event that the committee wishes, I am sure that we can
make such articles available to the committee.
Mr. Heselton. I expect that the staff can get whatever we need
from the Library of Congress.
Mr. Hale. Are there any further questions ?
Mr. Harris. Mr. Chairman.
Mr. Hale. Mr. Harris.
Mr. Harrls. Dr. Doty, I have not had a chance to look over your
brief statement, and regret that I did not get here in time to hear
you deliver it. You may have covered this. You did, I notice, refer
to the amount of fluorine in water by artificial means.
Dr. Doty. Yes.
Mr. Harris. Now, it is true, is it not, that some areas ot the country
and of the world have more natural fluorine in the water than they
do in other areas; is that right?
Dr. Doty. They naturally contain higher amounts, it is all tlie
same fluorine, because, after all, man does not create fluorine. All
of the fluorine which is available is that which occurs m various de-
posits in nature, but some water naturally contains higher amounts of
fluorine than other waters. Yes, you are correct.
Mr. Harris. Now, the natural fluorine is the same as the fluorine
that you put in by artificial means? . , • ^u i. 4.
Dr. Doty. Yes, sir ; that was covered quite extensively m the state-
ment.
Mr. Harris. Yes. . u xi, ^
Dr Doty. And was directed to the attention of the members that
some very eminent chemists have filed statements for the committee
for use in that regard. • j, • ^
Mr. Harris. Yes, I appreciate that and the purpose m referring to
it is to get your comment on a statement that was made that m cer-
FLUORIDATION OF WATER 303
tain areas of tlie countrv, the water of that area has a greater amount
of fluorine in it than others, and it is shipped for consumption into
other areas of the country, where they do not liave a large amount of
fluorine in their products, and consequently it has been contended that
those people might get a double dose.
Have you covered that in your statement ?
Dr. Doty. I think I have^to some extent. That is largely a miscon-
ception.
The increase in the fluoride content of plant products is not large.
The only tyjDe of food product in which the concentration of fluoride
would increase considerably in a so-called high fluoride area, would
be those products which contain bone, because as animals become older,
and as they use, or as they are fed larger amounts of fluorine, a con-
siderable amount of that fluorine would be deposited in the bones of
that animal, but not the soft tissues of the animal.
Mr. Harris. That is all, ISIr. Chairman. Thank you very much.
Mv. Heselton. Mr. Chairman.
Mr. Hale. ]Mr. Heselton.
Mr. Heseltox. I do not recall ever having seen any fluorine. This
is probably a peculiar question to ask, but can you tell us what fluorine
is ? Is it a fluid or a solid substance ?
Dr. DoTT. Well, fluorine in elemental form, which never occurs as
such in nature, is a gas ; but when fluorine is embodied with other chem-
cal elements, as it always is when it is found in nature, it will ordi-
narily be a solid.
Now, the sodium fluoride which is used quite extensively in water
fluoridation is an ordinary white solid. It would be indistinguishable
in general appearance from many other similar chemical compounds.
The fluoride which is added to water is a fluoride compound which
will provide a fluoride ion to the water, because in the analytical pro-
cedures which the control chemist applies to the water he measures
by a chemical analysis the amount of fluoride ions
INIr. Heseltox. You say ions ?
Dr. Doty. That is correct.
Mr. Heseltox. Would j'ou enlighten me on what that is?
Dr. Doty. That would have to be a somewhat technical explanation.
It depends somewhat on an extensive knowledge of atomic structure,
and the fluoride ion is formed when an outer electron shield of the
fluoride atom takes up an electric, an additional electric ion. I am
sorry that I cannot put it in simpler terms.
j\ir. Hale. We will have to accept the fact that there are ions and
let it go at that.
Mr. Heseltox. Yes.
j\Ir. Hale. Doctor, I want to ask you a couple of questions. The
effect of fluorine on the teeth, or the desired etfect is, of course, to
harden them. Does it have a similar efi'ect on the bones ? I have under-
stood that you testified tliat it has a similar effect on the whole bone
structure of the body. Is that right?
Dr. Doty. The beneficial efi^ect of this fluoride is on the teeth. The
exact mechanism which is involved in producing that protective effect
is not completely known ; whether it is due to a hardening effect or
whether it is due to a different type of effect, I think it would be better
not to go into the theories involved in that. Now, if a comparatively
304 FLUORIDATION OF WATER
large amount of fluorides are ingested by an individual, the bones will
become somewhat harder and somewhat more resistant to breaking.
However, there is a great deal of variation in that effect, and I doubt
if any such affect upon the bones has ever been detected at the low
levels which are involved in the ordinary processes of fluoridation.
Mr. Hale. It certainly does not do any practical harm to the bones ?
Dr. Doty. There have been very extensive studies of that. For
example, Dr. McClure, at the National Institutes of Health, observed
a very large number of inductees, comparing those who had lived
throughout their lifetime in areas where water contained fluorides,
comparing those individuals with the same aged individuals who had
lived throughout their lifetime in areas which did not have fluorides
contained in their water. He went back and obtained the history of
all of the fractures, breaking of bones of those individuals.
He studied the heights, the weights and other factors of that sort
pertaining to those individuals and he found no evidence that there
was any higher experience of fractures or breaking of bones in those
individuals who had lived in the fluoride areas than others.
Mr. Hale. It does not make them brittle so far as anyone knows?
Dr. Doty. No, not at these levels.
Mr. Hale. The only other question I wanted to ask you is with
relation to the natural foods in which a trace of fluoride is observed.
Can you give a few samples or illustrations?
Dr. Doty. Well, the largest amount, so far as ordinary foods are
concerned, would be any food which contains bone.
Mr. Hale. Contains what?
Dr. Doty. Bone of animals. That is, there are a few foods to which
bonemeal is added. The meal is made by grinding up the bones of
certain animals.
Now, as I have pointed out, when animals ingest fluorides through-
out their lifetime, they deposit some of that fluoride in the bone, in
the skeleton, and if the bones are included as a supplement or as a part
of the food material they will naturally carry some of that.
Now, I should point out further, however, that this fluoride which
is found in bones is not only very slightly soluble, but it takes a con-
siderable period of time to bring it into solution. So that when a
bonemeal is eaten by an individual or food containing monemeal, only
a fraction of the fluoride from that bonemeal will actually be absorbed
by an individual and will reach his blood stream.
Now, another type of food which contains a comparatively large
amount of fluoride is tea leaves, for example, oftentimes containing
a fairly large amount of fluoride, except it is not eaten, and since
we never use it in very large amounts, very large amount of tea leaves
at any time, it does not provide a very large amount for human intake.
Some fish products also contain fairly high amounts of fluoride as
compared to other food products.
Mr. Hale. There is a perceptible amount of fluoride in a cup of tea?
Dr. Doty. Yes, there is; not a harmful amount, certainly. I am not
sure that there is enough to do any good, but I am sure there is not
enough to do anv harm.
Mr. Hale. The putting of bonemeal on grass, for example, that
does contain fluoride, does that have any effect —
FLUORIDATION OF WATER 305
Dr. Doty. Tlie bonemeal itself contains fluoride, but I know of
no evidence that it contributes to the fluoride content of the grass.
Mr. Hale. Thank you very much, Doctor. Your presentation has
been extremely enlightening, and very helpful.
Dr. Doty. Thank you.
Mr. Hale. Before proceeding further with the testimony of any
other witnesses, the Chair would like to inquire as to the number of
individuals present who desire to testify, because our time is limited.
We have to conclude these hearings today and the forenoon is pretty
well gone.
Is Dr. W. D. Armstrong, University of Minnesota, present?
Dr. Armstrong. Yes, Mr. Chairman,
Mr. Hale. Is Dr. I^rancis F. Heyroth, American Public Health
Association, University of Cincinnati present?
Dr. Heyroth. Here, Mr. Chairman,
Mr, Hale. You both desire to testify?
Dr. Armstrong. Yes, Mr. Chairman.
Dr. Heyroth. Yes, Mr. Chairman.
Mr. Hale. Is Dr. John Knutson, chief dental officer. Public Health
Service present ?
Dr. Knutson. Here, Mr. Chairman.
Mr. Hale. And Dr. Nicholas C. Leone,
Dr. Leone. Yes, sir.
Mr. Hale. Dr. Isidore Zipkin, National Institute of Dental
Research.
Dr. Zipkin. Here, Mr. Chairman.
Mr. Hale, Maj. Robert W. Hobson.
Major HoBSON. Here.
Mr. Hale. All of the gentlemen whose names I have called are
prepared to testify and desire to testify, is that correct ?
(There were numerous affirmative answers.)
Mr. Hale. The Chair has some other names.
Dr. John D, Porterfield, the Association of State and Territorial
Health Officers.
Dr. Porterfield. Yes, sir.
Mr. Hale. You desire to address the committee ?
Dr. Porterfield. If I may, sir.
Mr. Hale. And Dr. Harris and Mr. George W. Welsh.
Mr. Welsh. Yes, Mr, Chairman.
Mr. Harris. Yes, Mr. Chairman.
Mr. Hale. Mr. Harry E. Jordan, secretary, American Water Works
Association, 521 Fifth Avenue, New York, N. Y.
Dr. Knutson. I would like to testify in behalf of Dr. Jordan.
, Mr. Hale. And, Mr. Joseph B. Meegan.
The Clerk. His name has been crossed off.
Mr. Hale. That makes nine witnesses.
The Clerk. Mr. Welsh and Mr. Harris are together.
Mr. Hale. Mr. Welsh and Mr. Harris are together.
I think that we cannot afford to give more than, certainly more than
15 minutes to any witness.
Dr. Armstrong, will you address the committee ?
306 FLUORIDATION OF WATER
STATEMENT OF DR. WALLACE D. ARMSTRONG, PH. D., M. D., MEDI-
CAL SCHOOL, UNIVERSITY OF MINNESOTA, MINNEAPOLIS, MINN.
Dr. Aemstkoxg. Mr. Chairman and members of the connnittee:
My name is Wallace D. Armstrong.
I should like first to identify myself and state my qualifications for
presentation of testimony at this hearing.
I am professor and head of the department of physiological chemis-
try in the medical school of the University of Minnesota. I hold the
doctor of philosophy degi'ee with a major in physiological chemistry
from the University of Minnesota ( 1933) . I am also a doctor of medi-
cine (University of Minnesota, 1937) and I am licensed to practice
medicine in Minnesota.
I am a Fellow of the American Association for the Advancement of
Science and I am a member of the American Chemical Society, the
American Society of Biological Chemists, the Society for Experimen-
tal Biology and Medicine, the Northwestern Pediatric Society, the
Minnesota Academy of Medicine, and the International Association
for Dental Research. I was president of the latter association in
1945-46.
I am the author of 70 published scientific papers exclusive of ab-
stracts of communications presented at meetings of scientific societies.
Eight of these papers have dealt with the development of methods
for the analysis for fluoride in natural materials. Thirteen other
papers have described my research in various aspects of the biochem-
istry and clinical use of fluoride.
Thirty-five other papers have been concerned with other investiga-
tions in the field of biochemistry and physiology of bones and teeth.
I have been engaged in the investigation of the chemistry and metab-
olism of fluoride since I wrote my doctor of philosophy thesis in 1933
on "Studies in Fluoride Analysis."
It is my opinion, based on my own work and on that of other investi-
gators, that correctly controlled fluoridation of public water supplies
affords a means for effectively reducing dental decay which is safe as
regards all aspects of health.
I shall discuss only the evidence for the health safety of fluoridation
of water supplies since it is stated in the title of Congressman AVier's
bill that its purpose is to protect the public health. I assume that the
benefits of fluoridation on dental health are accepted and recognized
and are not a topic for consideration at this hearing.
Dr. Doty has covered most of this.
ANiaiAL AND BIOCHEMICAL STUDIES INDICATE SAFETY OF FLUORIDATION
Laboratory studies by numerous investigators with several species
of animals have shown that experimental animals tolerate many times
as much fluoride as is present in correctly fluoridated water without
any harm to growth, reproduction, longevity, bone structure, or alter-
ation of any measurable physiological function.
For example, my own work contains 15 parts per million of flu-
oride in water, on mice, showed no effect on growth in the animals.
The bone growth of experimental young and mature rats was not
altered by water containing 20 parts per million of fluoride. Other
FLUORIDATION OF WATER 307
i n vest ifjii tors, Avhose work is too vohiiiiinoiis to review in detail, have
in prolono-ed and extensive stndies made similar observations on this
point.
Biochemical studies have shown that the bones and forming teeth
are the only tissues which accnmnlate fluoride. The other tissues
promptly eliminate fluoride followinf^ which it is excreted in the
urine, perspiration, and feces. This point is sio-niiicant because these
mechanisms of prom]:>t and laroe excretion of fluoride and of seques-
tration of fluoride in bone mineral, of wliich there are several acres of
surface in the human body, ])rovi(le tooetlier an ellicient means for
regulation of the fluoride content of the body iiuids. In these ways
the fluoride content of the body fluids (excei)t under coiulitions of
excessively larae fluoride intakes) is kept below that which aft'ects
enzymes.
Our own studies with acid phosphates and enolase, two enzymes
which are among the most sensitive to fluoride show that it is incon-
ceivable that enough fluoride to alter the action of these enzymes could
be produced in tlie l)lood and body fluids by use of fluoridated waters.
FLUORIDATED WATER XOT CARCIXOGEXIC FOR 'SUCV.
It has been alleged that the use of fluoridated water may increase
the incidence of cancer and other degenerative diseases. Aj)parently
the fears of fluoridation with respect to cancer are grounded on the
experiments of Dr. Alfred A. Taylor which were described by Dr.
Taylor in his testimony before the Delaney (^onmiittee (hearings
before the House Select Committee to Investigate the Use of Chemi-
cals in P'oods and Cosmetics, House of Representatives, 82d Cong.,
pt. 8, pp. 1529-1548: year 1952).
Dr. Taylor in various experiments gave drinking water containing
0.45 to 4.5 parts per million of fluoride to mice of a sti'ain which
develo])s spontaneous l)reast cancer. He interpreted his observations
to iiulicate that the incidence of cancer among the animals was not
affected by the fluoridated water but that the cancer developed earlier
in the animals which received the fluoridated water.
Following the publication of Dr. Taylor's work in the transaction
of the Delaney conmiittee, I conductecl an experiment also designed
to test the effect of fluoride in drinking water on breast cancer in mice.
In this work I had the collaboration of Dr. fJohn J. I>ittner, of the
^[edical School of the University of Minnesota — Dr. Bittner is un-
doubtedly one of the world's authorities in research on the biology
of breast cancer in mice. The results of our study showed that the
development of breast cancer in the mice was not accelerated by 5 to
10 i^arts ])er million of fluoride in the drinking water.
The Fi females of ZDo hybrid mice were maintained as virgins and
distributed in three groups labeled A, B, and C shortly after weaning.
Litter mate mice were distributed among the three groups. The ani-
mals were housed 10 to a cage and were all given the same food which
was a standard stock diet commonly used for feeding laboiatory mice.
The animals in group A received distilled water cojitaining 5 parts
])er million of fluoride, those in grouj) B received distilled water con-
taining 10 ])arts ]ier million of fluoride and the animals in gi'oup C
received distilled water which contained no fluoride.
308
FLUORIDATION OF WATER
I made up the waters and supplied them in large bottles to Dr. Bitt-
ner in such manner as not to disclose to him the fluoride content of
the waters. Dr. Bittner conducted the animal work and exarnined
the mice twice weekly. He recorded the date on whicli each individual
animal developed a diagnosable breast tumor.
Since Dr. Bittner did not know the fluoride content of the waters
or even which waters contained fluoride, the effect of possible uncon-
scious bias on the results was eliminated. At the termination of the
experiment the data was tabulated by Dr. Bittner who was still unin-
formed as the amounts of fluoride in the waters.
Dr. Alan E. Treloar, professor of biostatistics in the Medical School
of the University of Minnesota, then analyzed the data by statistical
methods in order to provide tests of significance between the results
obtained with the animals in the three groups. The results of the
eperiments are summarized in table 1 so as to show the mean age of
the animals at which cancer was diagnosed.
Table 1. — Comparison of ages at which mice receiving distilled water or highl
fluoridated water as drinking water developed breast cancer
Group
Number of
mice
Fluoride
content of
water
Mean age at
diagnosis of
cancer
Standard
deviation
A
36
34
31
P. p. m.
5
10
0
Days
360.4
398.6
398.3
Days
91.31
B .
96.29
c
96.18
Group C, in which the mean cancer age was 398.3 days, can be con-
sidered to be a control group since the mice in this group received
distilled water. The animals of group A received water containing 5
parts per million of fluoride and developed cancer at a mean age of
360.4 days. This result is not statistically different from the mean
of group C and would be expected to occur 10 times in 100 by chance.
The lack of significance between the results obtained with groups
A and C is further demonstrated by the results obtained with group
B. The animals of group B received water containing 10 parts per
million of fluoride, a concentration which was twice that of the water
drunk by the animals of group A. The mean cancer age of the animals
of group B was 398.6 days, a result which is obviously equal to that
obtained with the animals of group C, namely 398.3 days.
Dr. Treloar further writes :
The differences between the means of groups A, B, and C have been sub-
jected to critical statistical examination in the form of an analysis of variance.
The ratio of ''between means" variance to "within classes" variance, the F
value, is 1.8S. This falls so far short of the minimum value of 3.09 required by
accepted standards for any significance to be assigned, that the differences must
properly be regarded merely as chance fluctuations.
In summary, our experiments do not confirm the hypothesis that
fluoridated drinking water accelerates the development of breast can-
cer in mice.
FLUORIDATION OF WATER 309
EXPERIMENTS WITII THE HUIVIAN DEMONSTRATE SAFETY OF FLUORIDATION
Laboratory studies are important in considerations of the safety of
fluoridated waters. However, the experiments of prime significance
for the human are the experiments of nature. These experiments
have been conducted by nature with human subjects over many years
in numerous communities in the United States in which high amounts
of fluoride occur in the water. In many of these communities the
water contains much more fluoride than that which is needed for
dental-health reasons.
We have only to observe the results of nature's experiments in
order to gain conclusive evidence of the safety of fluoridation. Un-
doubtedly other persons have or will testify m detail on this point.
I will only summarize the observations which have shown (1) the
crude death rates from all causes and the specific death rates due to
cancer, heart disease, nephritis, complications of pregnancy, and
infectious diseases are not different in the communities with high and
low fluoride waters, (2) stature and weight and history of bone frac-
tures are not related to the fluoride content of the community water,
and (3) no evidence of increased incidence of skeletal osteosclerosis
has been found in inhabitants of communities with waters of a high
fluoride content.
FLUORIDE NOT NEW IN HUMAN METABOLISM
Intake of fluoride in food and water is not a new metabolic experi-
ence for the human and undoubtedly has occurred throughout the
whole of the evolutionary development of man. The evidence for this
conclusion derives from the wide distribution of fluoride in foods
and waters. Practically all soil waters contains some fluoride and
many contain large quantities of this ion,
I have never found a single natural article of food to contain no
fluoride. Even the highly purified food table sugar (sucrose) accord-
ing to my analyses contains detectable fluoride (5 x 10'''%). My own
studies indicate a daily intake of 0.19 to 0.32 milligrams of fluoride
from the food of an average adult human dietary.
Further evidence for the normal and common intake of fluoride by
the human is obtained from the fact that in my experience I have never
found a human tooth or bone (animal or human) to be devoid of
fluoride. These considerations indicate that fluoridation of water
which, as you know, is actually a process for adjustment of the fluoride
content of water, would not introduce into the body a substance for
which the body lacks metabolic experience.
CONTROLLED FI.UORIDATION THE EQUIVALENT OF NATURAL FLUORIDATION
There are no reasonable grounds to doubt that fluoridation with a
properly chosen fluoride salt (or compound) gives the equivalent of
natural fluoride in water. In either case all evidence points to the
existence of fluoride ions from whatever source is to deny one of the
most fundamental premises of chemistry which requires the uni-
formity of identity and properties of an element.
Evidence of the equivalence of fluoride in water from natural and
so-called artificial sources has been obtained from their equal behaviors
310 FLUORIDATION OF WATER
in analytical chemical reactions and from laboratory experiments with
animals. Furthermore, the reduction in dental caries attack rates
produced by artificial fluoridation programs in Grand Rapids, Evan-
ston, Newburoh, and so forth, demonstrates the physiological identity
of fluoride added at the waterworks to that dissolved into waters from
soils and rocks.
TOXICITY IS NOT QUALITATI^T:
Misunderstandings have arisen in discussions of fluoridation of
water owing to the fact that very large amounts of fluoride are toxic.
When sodium fluoride is employed as a rat or cockroach poison, the
dry and nearly pure compound is used. The aim is to produce acute
lethal fluoride intoxciation in the vermin, a circumstance which would
i-equire an impossibly large intake of fluoridated water. In water
fluoridation the fluoride compound is highly diluted to one part o"f
fluoride in a million parts of water.
It is not possible to state categorically that any substance is a poison
without defining the amounts of the substance or the conditions of its
administration. And this applies to fluoride also. Numerous sub-
stances, including many required by the body, are toxic when taken
in large amounts. Dr. Doty has already referred to vitamin A. For
example, the essential vitamin D produces toxic effects in human when
given in careless overdosages. One further example, air contains 21
percent oxygen and we breathe air in order to obtain oxygen for essen-
tial body needs. If an animal breathes pure oxygen, particularly
imder pressure, it will suffer ill effects and if the experiment is con-
tinued long enough the animal will surely die. Under these condi-
1 ions oxygen is a poison.
Mr. Hale. Thank you, Dr. Armstrong. Are there any questions?
The committee is indebted to you, sir.
Dr. Armstrong. Thank you.
STATEMENT OF DR. FRANCIS F. HEYROTH, M. D.. PH. D., ASSOCIATE
PROFESSOR OF INDUSTRIAL TOXICOLOGY AND ASSISTANT DI-
RECTOR OF THE KETTERING LABORATORY, DEPARTMENT OF
PREVENTIVE MEDICINE AND INDUSTRIAL HEALTH, COLLEGE
OF MEDICINE, UNIVERSITY OF CINCINNATI, CINCINNATI, OHIO
Mr. Hale. Dr. Heyroth, the connnittee will hear you.
Dr. Heyroth. Mr. Chairman and gentlemen of the committee. My
name is Francis F. Heyroth. I hold the degrees of M. D. and Ph. D.,
both from the University of Cincinnati. I am associate professor
of industrial toxicology and assistant director of the Kettering labo-
ratory in the department of preventive medicine and industrial
health, college of medicine, University of Cincinnati. I also serve
as associate professor of biological chemistry in the college of medi-
cine and as a member of the Cincinnati Board of Health.
The Kettering laboratory studies the dangers to workmen and con-
sumers that attend the manufacture and use of potentially toxic sub-
stances. Its work on fluorides began more than 20 years ago shortly
after fluorosis became recognized in Denmark as an occupational
abnormality, occurring among men engaged in grinding a mineral
known as cryolite or sodium aluminum fluoride. In the course of
FLUORIDATION OF WATER 311
routine X-ray examinations of these Danish workmen, an increase
in the density of the shadows of the bones of many of them was noted.
This was of a type not hitherto encountered. It was subsequently
established that it was an effect associated with the accumulation of
fluoride in the bones.
Our laboratory has made many observations on experimental ani-
mals and on human volunteers in the effort to learn the fact of known
amounts of fluorides when ingested daily over prolonged periods.
We sought to find what part of the dose is excreted in the urine and
how much is retained in the body, where it is stored in the bones.
Our goal was to determine the maximum amount that a workman
might absorb daily into his tissues without storing too much in his
bones.
I happen to be a member of the Cincinnati Board of Health. When
the Cincinnati Board of Health was asked for an opinion on the
advisability of fluoridation, I reviewed the data of our laboratory
tind the extensive published literature oji the toxicity of fluorides at
the request of my fellow members. My report to the board was recently
reprinted by the British ]\Iinistry of Health as an appendix to the
report of its mission to investigate fluoridation in North America.
THE NATURE OF H. R. 2 :5 4 1
This bill represents an attempt to initiate Federal legislation on
the fluoridation of public water supplies now in progress in hundreds
of cities and towns as a public-health measure for lessening the prev-
alence of dental decay. The House Select Committee to Investigate
the Use of Chemicals in Foods, the Delaney committee, devoted 7
days in 1952 to hearings on fluoridation and issued a report on this
subject dated July 10, 1952. The opening two sentences of the final
I^aragraph of its conclusions and recommendations read as follows :
The advisability of fluoridating the public water supply of the Nation is
essentially a local problem, to be determined for itself by each community.
Tour committee is not recommending that Federal legislation be enacted in this
field.
About 6 months later, H. R. 2341 was introduced and referred to
your committee. It reflects the unwillingness of those opposed to
fluoridation to abide by the locally arrived at decisions of the many
communities that have adopted this public health measure and seeks
to negate their decisions by Federal edict. Those promoting this bill
may be doing so in the belief that the United States Public Health
Sesrvice is seeking to promote the universal fluoridation of the wafer
supplies of the Nation. If so, they are incorrect. Fluoridation is re-
commended only for those communities whose water supplies contain
from natural sources less than the amount that has been shown to be
optimal for dental health. In most areas this is 1 part per million:
in a few, it is somewhat less. Where grossly excessive amounts occur
naturally the Public Health Service has actvised and insisted on the
installation of equipment for the removal of the excess.
The clause in H. R. 2341 that states that "no agency of any State
or of any municipality or other political subdivision of the State shall
treat any public water supply with any fluoride compound" soems an
attempt to exercise powers that are reserved to the States. If the bill
becomes law some of its provisions might create difficulties where
312 FLUORIDATION OF WATER
fluoridation is in progress. An interstate common carrier might be
enjoined from obtaining its supply of drinking water from a city where
the water is fluoridated.
Any justification that the bill may have depends upon the validity
of the premise in its opening clause, "To protect the public health
from the dangers of the fluorination of water." The evidence that this
is false and that fluoridation is safe has been brought together in three
publications by me which constitute the essence of m^'^ statement and
which I have submitted to the clerk for distribution to the committee.
And, I might interpolate, in preparing this report I felt deeply the
sense of responsibility which had been placed upon me by my official
position.
1. My report to the Cincinnati Board of Health, dated January 26,
1951.
2. Reprints of an article "Toxicological Evidence for the Safety
of the Fluoridation of Public Water Supplies," published in the Amer-
ican Journal of Public Health, 42, 1568-1952.
3. Reprints of a letter to the editor of Industrial and Engineering
Chemistry, 45, 2369-1953— entitled "Effectiveness and Safety of Flu-
oridation of Public Water Supplies."
These may be summarized briefly as follows : The evidence derives
from four sources, (1) animal and (2) human experimentation, (3)
epidemiological studies of the health of residents of communities whose
water bears excessive amounts of fluorides, and (4) the results of the
medical examination of workmen exposed to fluorides in industry.
Values for the maximum daily intake of fluoride that may be tole-
rated by animals of various species have been found from the results
of the very great number of experiments performed since 181^)0. Ex-
pressed in milligrams of fluoride per kilogram of body weight, these
values are : dairy cattle, 1 to 3 ; swine, 5 to 12 ; rats, 10 to 20 ; guinea
pigs, 12 to 20 ; chickens, 35 to TO. I shall mention only one experiment
done in our own laboratory. Each of two 11-months-old littermate
dogs was given daily 65 milligrams of fluoride; the third littermate
was given none. One dog was given its fluoride as the sodium salt,
while the other was given it as cryolite. The administration was con-
tinued for 5 years and 5 months. It was stopped because of the death
of the dog that had been given none. During life, no osseous changes
could be detected roentgenographically in any of the dogs. Storage
occurred in the bones, for the ash of those of the dog given sodium
fluoride contained 10 times the amount of fluoride found in those of
the dog used as control, and given none. No noteworthy histopatho-
logic changes were found in the organs of the fluoride-fed dogs.
The painstaking human balance studies of our laboratory referred
to in my introduction offer direct evidence as to the manner in which
men and women disposed of the fluoride they took. One of our volun-
teers took daily 12 milligrams of fluoride as tablets of sodium fluoride
over a period of 130 weeks. This daily dose represents the amount
present in 12 quarts of fluoridated water with 1 part per million.
Careful medical examination made at the end of this period revealed
no evidence of any harm. Other persons took lesser doses. In none
of our volunteers did any radiographic change occur in the density
of their bones, even though one of them had taken 21 grams of sodium
fluoride over a little more than 2 years.
FLUORIDATION OF WATER 313
The objection that 2 years is too short a period to permit conclu-
sions to be drawn does not apply to the third line of evidence — the
study of the health of persons who have lived to advanced age where
the water supply contains from natural sources more than 1 part per
million. Hodges found no evidence of skeletal fluorosis in X-rays of
31 persons who had lived for 18 to 68 years at Bureau, 111., where the
water has 2.5 parts per million, or in those of 86 residents of Kempton,
111., where the content has varied between 1.3 and 3 parts per million.
We have had examined the X-rays of 50 persons living in Lake Pres-
ton, S. D., where the water has 6 parts per million. One radiologist
found minimal changes in two of these persons, but another radiologist
could not agree that the changes were real, or beyond the normal range
of variation. A radiologic survey of 114 persons who had lived for at
least 15 years at Bartlett, Tex., where the water has 8 parts per mil-
lion revealed minimal evidence of an increase in density of the bones
of 12 percent of those examined, but in no case was there any deform-
ity or interference with skeletal function. Medical examinations,
which included urinalyses and blood counts, gave no evidence that the
residents of Bartlett were any less healthy than were those of nearby
Cameron, w4iere the water contained only 0.3 parts per million. We
have found that the average daily intake of fluoride by a 63-year-old
man and his 57-year-old wife, long resident in Bartlett, amounted to
15.3 milligrams, while their urinary concentration approximated very
closely that of the drinking water, 8 parts per million.
The examination of men long exposed in industry to a fluoride-con-
taminated atmosphere offers further evidence. The average urinary
concentration of the previously mentioned Danish workers amounted
to 16 milligrams per liter or twice that of the 2 residents of Bartlett
studied by us. Medical studies ot men in industries of the United
States have been made to establish the safe level of the industrial envi-
ronment. On comparing their X-ray findings and urinary output with
those of persons who acquire their fluoride from water, it is found
that an increase in bone density may be detected at a daily intake of
about that tliat corresponds to the use of drinking water with 5 or more
parts per million.
All 4 lines of evidence lead to the conclusion that fluoridation of
water to 1 part per million has an ample margin of safety.
On behalf of the American Public Health Association, which in
1950 adopted a resolution recommending fluoridation, I wish to thank
the committee for affording me the opportunity of appearing before it.
In other words, no evidence could be found of any harm by examina-
tion of the bones, so long as the drinking water did not contain 5 parts
at least, and very minimum if any change occurred when it contains
4, 5 or more.
Mr. Haij:. Thank you. Dr. Heyroth. Are there any questions, gen-
tlemen ?
Mr. Heselton. Mr. Chairman.
Mv. Hale. Mr. Heselton.
Mr. Heselton. Doctor, you have testified, and others have, that
approximately 1 part per million is the safety factor that you observe.
Would you explain why it is that during hot weather that amount
is reduced ?
Dr. Heyrotii. Yes. The water intake is believed to be a little higher
during hot weather. There are a few cities that change the amount
314 FLUORIDATION OF WATER
added for fluoridation Avith the season. Charlotte, N. C, is one, I
think. They drop it to about eight-tenths of a part per million in
warm weather and increase it to l.t2 parts per million in cold weather,
merely because of the variation of the amount of water that one would
drink.
Now, what occurs insofar as the intake of any particular day is
concerned, is of rather little importance. It is how much is taken in
over the months and over the entire year that counts.
So, one endeavors to make it come out at an average income, intake
per day over a year of 1 part per million. To do that in summer, you
may have a little less in the water, because you drink more water.
Mr. Heselton. Then it is not universally done ?
Dr. Heteoth. Not universally done ; no. That is up to the regu-
lations of the health department or the water-works board, or the
council of the local community.
Mr. Rogers. Mr. Chairman.
Mr. Hale. Mr. Rogers.
Mr. Rogers. Doctor, I believe that you agree with the statement
made here to the committee with the gentlemen who commented on
this, and in which they stated that the water supply of the Nation is
essentially a local problem and the passage of this would be encroacli-
ment on States' rights. Is that not true ?
Dr. Heyroth. That evidently is the thinking on it.
Mr. Rogers. Do you not agree with that ?
Dr. Heyroth. Certainly.
Mr. Rogers. Well, I do, too.
Thank you very much.
Mr. Harris. Mr. Chairman.
Mr. Hale. Mr. Harris.
Mr. Harris. Doctor, you explained that the Cincinnati Board of
Health asked you for an opinion on the value of fluoridation. What
was the action of the city of Cincinnati with reference to fluoridation?
Dr. Heyroth. I happened to be a member, as I said, of the Board
of Health.
Mr. Harris. Yes,
Dr. Heyroth. I gave the report to which I referred to my fellow
members on the board, and you have a copy of it.
Mr. Harris. Yes.
Dr. Heyroth. The board approved it unanimously. It went in to,
in due course, to the city council. They approved it unanimously.
At abount that time a radio commentator began arousing fears on
the part of the Cincinnati public. He appeared before the council.
They conducted a public hearing, at the conclusion of which they
revoted on the question.
Mr. Harris. You mean the council revoted ?
Dr. Heyroth. The council revoted. This time, again, they were
in favor of it by 8 to 1.
Mr. Harris." Wliat?
Dr. Heyroth. By 8 to 1, in favor of it.
Mr. Harris. 8 to i in favor of it?
Dr. Heyroth. In favor of it ; yes, sir. But, this was passed not
as emergency legislation and under the city laws they have
Mr. Harris. Now, wait a minute. I misunderstood you. I thought
vou said the first time that they approved it.
FLUORIDATION OF WATER 315
Dr. Hetroth. They a]:>proved it nine to nothing.
Mr. Harris. Nine to nothing the first time ?
Dr. Heyroth. Yes, sir.
Mr. Harris. And tlien they reconsidered it and the second time
they approved it 8 to 1 ?
Dr. Heyroth. That is right ; but under our laws, unless an ordinance
is introduced under an emergency clause — and this was not — then,
the citizens have a right to petition for the repeal of that ordinance
or for an election for the repeal of it. It takes a tenth of the registered
voters in the community, from the last election.
Mr, Hesei.tox. How many ?
Dr. Heyroth. Ten percent of the voters. They secured a petition
with an ample majority, I might say, so that it was forced to an
election. It was defeated at the election by — it was 77,000, I think,
against fluoridation and 55,000 for fluoridation.
Mr. Harris. Was that a substantial vote; or was that a rather large
vote or small vote ?
Dr. Heyroth. No, it was not and there was about — the difference
between those two figures represented voters who voted on other issues,
but did not vote on that particular issue.
Mr. Harris. That is all. Thank you.
Mr. Hale. Any further questions ?
]\rr. Bea:\ier. ^Nlr. Chairman.
INIr. Hale. Mr. Beamer.
Mr. Beamer. Doctor, I am somewhat concerned about this. I notice
that the bill spells the word with an "n" and on the statements the
others spell it with a "d".
Dr. Heyroth. That is correct.
Mr. Beamer. I would like to have vou explain that.
Dr. Heyroth. Yes. Fluorinated, as in the bill, is not correctly
drawn. Fluorine would refer to the introduction of fluorine gas and
water, which would be physically impractical, or impossible. What
is introduced is a fluoride salt. The fluoride ion. So, it is fluoride
that is introduced and it is frequent therefore to call it fluoridation.
]\rr. Beamer. The bill i? probably incorrectly drawn, then, if it were
to be considered ; is that correct ?
Dr. Heyroth. I would think so, on any technical ground; j^es, sir.
Mr. Pelly. ISIr. Chairman.
Ur. Hale. Mr. Pelly.
Mr. Pelly. Doctor,' I notice that the experiments that have been
conducted, as referred to in your testimony, have to do with the effect
of the incidence of fluorine on cancer and on the bone structure.
Can you tell me if there has been any investigation as to the effect
on such things as the sterileness of cattle or human beings in commu-
nities in relation to the proportion of fluoride in their water ?
Dr. Heyroth. There has been a great deal of experimentation not
only on cattle, but on other animals.
According to the figures that I showed you, cattle are more suscepti-
ble than a great manv other species. I said 1 milligram per kilogram
of body weight was about the maximum that could be tolerated by cat-
tle, whereas chickens could go up to from 35 to 70. So, there is a big
difference between them.
Many varied physiological functions are included in those studies
and they are thoroughly reviewed in the work of Schmidt and Rand,
48.301 — 54 21
316 FLUORIDATION OF WATER
which can be seen in the Journal of Veterinary Medicine and which
is referred to in the small print which has been distributed.
Mr. Pelly. How about humans ; does the birth rate in the various
communities differ materially?
Dr. Heyroth. Not so far as anyone has been able to find out.
Mr. Pelly, Have they tabulated the statistics?
Dr. Heyroth. They have tabulated the figures at
Mr. Harris. Will the gentleman yield?
Mr. Pelly. Yes, I will yield to the gentleman.
Mr. Harris. Wliat could the human body tolerate?
Dr. Heyroth. You mean the amount per day, or total amount in
the body ?
There was found in the bones of two Danish workmen who died
of other causes, and a further examination was made of the bones;
they were analyzed in toto. One man had in his bones 50 grams and
the other had 90 grams. These men were still able to work, although
there were rather extensive X-ray changes. That would give you some
indication of how much might be in the body.
Mr. Pelly. How about the birth rate in the Danish communities
that were referred to?
Dr. Heyroth. These were, these were factory workers.
Mr. Pelly. Were any studies made of the workers in that factory as
to their birth rate?
Dr. Heyroth. Yes ; there were very elaborate studies, but I do not
recall them at the moment. There was a monograph, a very large-
book written on the subject of fluoride intoxication by Dr. Tirhom,
now dead, wiio conducted that work.
Mr. Pelly. What was the final analysis?
Dr. Heyroth. That there was no one particular sign of illness that
characterized the working population of that factory other than this
incidental and unexpected finding of an increased density in the-
shadows of the bone in the X-rays.
Mr. Pelly. That is all, Mr. Chairman.
Mr. HiNSHAW. Mr. Chairman.
Mr. Hale. Mr. Hinshaw.
Mr. Hinshaw. May I inquire of this distinguished gentleman, what
is the toxic dose of fluorine for man ?
Dr. Heyroth. Well, to answer that, w^e would have to say, taken in
what time ; taken at one time or what ?
Mr. Hinshaw. At one time.
Dr. Heyroth. At one time?
Mr. Hinshaw. Yes.
Dr. Heyroth. Well, I cannot answer that, for many causes. No-
body could make a statement. You can make an
]\ir. Hinshaw. I did not say lethal ; I said toxic dose.
Dr. Heyroth. Toxic dose?
Mr. Hinshaw. Yes.
Dr. Heyroth. I can only estimate, and I would say that one might
go — two-tenths of a gram might be taken with safety and probably
cause some illness. That is 200 milligrams ; 200 quarts of fluoridated:
water.
Mr. Hinshaw. Does anyone know what the lethal dose of any par-^
ticular specimen of life is?
FLUORIDATION OF WATER 317
Dr. Heyroth. Aiiioiiiit taken at one time by any particular species
of animal.
Mr. HiNSHAW. Yes.
Dr. Heyroth. That has never been precisely estimated by current
standards; but it probably lies around 8 milligrams per kilogram and
according to most recent discoveries, which I have referred to.
Mr. HixsiiAW. What would that amount to per 100 kilograms?
Dr. Heyroth. Seven kilograms is the average human weight — 30
times 70 ; 2,100.
Mr. HiNSHAW. A kilogram is a
Dr. Heyroth. A kilogram is a thousand grams.
Mr. HiNSHAW. It would be 2,100 milligrams.
Dr. Hey-roth. Yes. So it would be 2.1 grams.
Mr. HiNSHAW. Two and one-tenth grams.
Dr. Hey-roth. And that is in reasonable agreement with what can
be found from incidence in which poisons have occurred. You prob-
ably know that has happened when in an institution someone, by
mistake got sodium fluoride mistaken for baking powder, or flour,
and there have been some instances of that sort.
]\Ir. HiNSHAW. You mentioned the Delaney committee of Congress.
I believe Dr. Miller made a very strong statement in connection with
the Delaney committee report, in referring to this particular subject.
Dr. A. L. Miller is a Member of Congress and parenthetically I think
that the committee would do very well indeed to get Dr. Miller to
come u]) here and ask him some questions about it. I believe that you
can verify this when he comes here, but I have a quotation from his
report to the House of Representatives dated March 24, 1952, in which
he states :
A check on the vital statistics of Grand Rapids, Mich. — which is the only
city of any size that has had artificial fluoridation for more than 4 years —
shows "an increase of 50 i>ercent from the deaths from nephritis" and "an increase
of 50 percent, over a period of 4 years, and deaths from intracranial lesions."
The death rate from heart disease in the year 1944 numbered 585. Four years
later, after fluoridation had started, there were 1,059 deaths.
Now, have you gone into these statistics mentioned by Dr. Miller?
In reference to nephritis, intracranial lesions, and heart disease?
Dr. Hey'roth. On the statistical basis of the deaths you mentioned ?
Mr. HiNSHAW. Yes.
Dr. Heyroth. I would not be willing to accept the figures of Dr.
Miller as cited. I think they are in error. However^ there are people
who could answer that better, here, who are from the locality, from
Grand Rapids.
]Mr. HiNSHAW'. Mr. Ford represents the district in which Grand
Rapids is located. He testified here. But, I believe that Dr. Miller
has made some examination of the situation.
Now, I would like to ask what fluorine compound there is other
than sodium fluoride which could be used for fluoridation of water
with safety.
Dr. Heyroth. Theoretically there could be a great many, but prac-
tically, the only one in use is sodium silico fluorine. That gives the
fluorine ion in solution, and you have to change the actual weight of
the material to be added a bit, but you get the same concentrate of
fluorine ions, if you make the necessary adjustments.
318 FLUORIDATION OF WATER
Mr. HiNSHAw. And, do you believe that that would be a safe thing
to use ?
Dr. Heyroth. Yes.
Mr. HiNSHAW. In what numbers or parts per million ?
Dr. Heyroth. One part per million of the fluoride ion.
Mr. HiNSHAW. Now, you have spoke of sodium silico fluoride.
Dr. Heyroth. It does not matter what the source itself is as long
as it is fluoride ion. You may have to take more or less of it, of a given
compound, in order to get the same amount of fluoride ion. As a mat-
ter of fact, even calcium fluoride could be used, but it is not nearly so
soluble and would pose difficulties in the engineering plans, and water
plants, but it has been stated by water works authority that it is not
beyond the realm of possibility.
Mr. HiNSHAW. Now, you talk about the toxic dose or maximum
dose; and also the lethal dose. How much fluoride can the body of
man tolerate over a period of time ?
Dr. Heyroth. Well, we have made some observations recently in
which we have, in various parts of the country, where there is more
than there ought to be, fluoride present in the water. We have made
observations in which we have collected duplicate samples of every
bit of the food and water that those people have eaten and drunk for
3 months or more.
We have sent those duplicate samples of exactly what they ate and
drank to the laboratory for analysis, so we know what 2 people in each
of 10 different cities, by free choice actually ingested.
Now, these people are presumed to have been, during our study,
taking about the same amount of food and water that they have taken
all of their lives. Some at Bartlett had lived there several years and
were taking eight parts per million.
We have not found any X-ray evidence in those two persons that
we studied. And yet, their daily intake amounted to 15, on an aver-
age, 15 milligrams per day of the fluoride ion, and it lias not done them
any harm over several years, over a good many years.
So we know that they can take at least that much. Now, how much
would be toxic and would be dangerous to them, that will remain to
be explored by other industrial exposures.
Mr. HiNSHAW. I think that the Kettering Laboratory, of which
you are the assistant director, made a study of this question of inges-
tion of the fluoride ion, because it was recognized to be somewhat dan-
gerous or hazardous to the workingman, working with cryolites and
sodium, and aluminum, and other materials which they have. Is that
correct ?
Dr. Heyroth. That is correct. It was done under the sponsorship
of the industries that were handling the fluorides in order that they
might control the extent and nature of the hazard to which their
workmen were exposed, and to protect them.
Mr. HiNSHAW. Was it recognized as a hazard ?
Dr. Heyroth. Oh, yes ; it was recognized as a hazard ; certainly.
Mr. HiNSHAW. How did that hazarcl come to be recognized ?
Dr. Heyroth. Because of this Danish experience I mentioned in
industry ; cryolite workers in Denmark.
Mr. HiNSHAW. You say that they found that as a result of that
study?
FLUORIDATION OF WATER 319
Dr. Heykoth. That is right.
Mr. HiNsiiAW. And there was an increase in the density of the
shadow of the bone?
Dr. Heyroth, That is right.
Mr. HiNSHAW\ Now, is fluoride, or fluorine, or anything of the sort
of higher density than calcium?
DrT Heyroth. No ; it is not ; and people all wondered why is it it
becomes evident in the X-ray. The answer is that it must be affecting
the deposits of calcium at spots or near the spots where the fluoride
is deposited.
Mr. HiNSHAW. What is the effect ?
Dr. Heyroth. The calcium is visible under the X-ray.
Mr. HiNSHAW. What is the net effect of fluoride ; is there additional
calcium ?
Dr. Heyroth. There is not any displacing of calcium ; making more
calcium deposits in the adjacent area.
Mr. HiNSHAW. Now, in other words, fluorine does not have the same
effect as strontium.
Dr. Heyroth. I am not familiar with strontium.
Mr. HiNSHAW. I understand that it displaces calcium.
Dr. Heyroth. I am not qualified to go into the question of strontium.
Mr. Harris. Will the gentleman yield ?
Mr. HixsHAW. Yes ; I will yield.
Mr. Harris. Doctor, is there any difference between artificial fluo-
ridation and natural fluoridation insofar as results are concerned?
Dr. Heyroth. None anyone can detect.
INIr. HiNSHAW. Let me ask this question right along with that. Is
the natural fluoride salt as found in water, sodium fluoride?
Dr. Heyroth. No ; it is probably calcium fluoride. You see when a
salt dissolves in water it falls apart in positive ions or metallic ions,
like it does in calcium, potassium or any other metal you may wish to
consider. So, what actually exists and where it came from, you can
never tell by an analysis of the water,
Mr. HiNSHAW. You cannot tell what the components are.
Dr. Heyroth. Yes.
Mr. HiNSHAW. You can tell whether the particular components
were sodium fluoride, sodium silicon, or calcium fluoride, or what it
was?
Dr. Heyroth. They will be sodium ions and the fluorides and cal-
cium ions, and so on, but where they came from, or what rock stratum
they came from or what it was, you can never say, because they are
no longer present as they were when they were dissolved.
Mr. HiNSHAW. Why, if it is not insolution, it is not broken up?
Dr. Heyroth. No ; you have the positive ions and the negative ions,
which can be detected electrically. The positive ions will go to the
negative pole of the electric battery and opposite will take place about
the negative ions. They w^ill go to the positive side.
Mr. HiNSHAW. If you evaporate enough to get out a large quantity,
what takes place ?
Dr. Heyroth. Then, you bring these ions closer and closer together,
so that they crystalize as salts.
Mr. HINSHAw^ The masspectrometer also will indicate the com-
pounds in the water ?
320 FLUORIDATION OF WATER
Dr. Heyroth. Not while it is in the water. You have to get it free
from the water to use the masspectrometer. You have to vaporize the
water,
Mr. Priest. Mr. Chairman.
Mr. Hale. Mr. Priest.
Mr. Priest. I have just one or two questions.
Doctor, I was interested in the experiences you related with ref-
erence to the city of Cincinnati. There are "certain constitutional
questions involved in connection with this legislation before us that
I think we have to study very carefully. That Cincinnati experience,
of course, demonstrates that whether to fluoridate or not to fluoridate
still is a matter that may be decided by the people within the com-
munity. That is one question tliat I have in mind, and I want to
state at this point, if we recognize the authority of Congress to pro-
hibit fluoridation of local water supplies, do we not at the same time
recognize its authority to require such fluoridation ?
On the other hand, does not the authority to prohibit also imply
the authority to require anything to be done, if the Congress should
desire to do that?
Dr. Heyroth. That would appear logical to me. The whole ques-
tion is whether the authority is to extend over any individual local
community, either way.
Mr. Priest. It also involves the question in my mind, the legal aspect
of it as to how far the Federal Government should go into this field
of regulating strictly local water supplies, or local operations of any
type whatsoever, remembering as I view it, that if we may prohibit,
we may also at another time, and under other circumstances require
the local communities to take certain action without their judgment
being expressed locally.
I think it is a pretty basic problem that we have to consider in this
matter. I hope we may be able in the course of the hearings, to get
some more legal testimony on that question.
That is all, Mr. Chairman.
Mr. Hale. Are there any further questions? We thank you very
much. Dr. Heyroth.
Mr. HiNSHAW. Mr. Chairman. I would like at this point to introduce
a letter addressed to me from Dr. C. H. Carpenter, Glendale, Calif.,
which is in my district, and an editorial which appeared in the local
newspaper, and a very short pamphlet on the subject at issue prepared
apparently by Dr. Carpenter, in lieu of his coming to Washington to
testify, as he" has been unable to come here. I submit this and ask
that it be inserted in the record.
Mr. Hale. Without objection the letter and the editorial and the
other material will be accepted and embodied in the record.
(Tlie material referred to is as follows:)
Glendale, Calif., May 25, 1954.
Hon. Carl Hinshaw,
House Office Building, Washington, D. C.
Dear Congressman Hinshaw : Since I have been a specialist for the past 20
years in biochemistry as pertaining to physiology and pathological physiology of
the luiman system, I believe that I am especially qualified to present the dangers
of fluoridation of water supplies.
Due to recent illness, I do not feel able to make the trip to Washington, D. C,
at this time, but in accordance with our telephone conversation yesterday after-
noon, I am herewith inclosing our pamphlet, "Fluoridation— a National Menace,"
FLUORIDATION OF WATER 321
■which o\ir committee used in the city of Glendale in last year's election at which
time fluoridation was defeated 2^ to 1.
Inclosed is also a copy of a letter which I wrote to the editor of the Glendale
Independent a few days before the election and which letter was published in
that paper.
I am sending these to you in order that you may have them recorded for the
hearings.
In the pamphlet, "Fluoridation — a National Menace," I would suggest that
you have recorded at least articles Nos. 1, 5, 11, 12, 13, 14, and 15 since these
articles contain pei-tinent facts which it might be difficult or impossible for
members of the committee to secure elsewhere.
It must be recognized that any fluoride compound is not a normal physio-
logical part of any body tissue, but rather is an infiltration product.
I had a telephone conversation with one of my patients in Flagstaff, Ariz.,
last evening. He and an attorney patient of mine have been opposing fluorida-
tion in Flagstaff and speaking against it on the radio for the past several days.
Yesterday was election day in Flagstaff and he told me last night that the vote
was running 3 to 1 against fluoridation. When the people know the truth regard-
ing fluoridation, they will vote it down.
It is my personal opinion that there is enough authentic information in this
pamphlet to make the committee or any official see the danger and seriousness
of adding fluorides to public di'inking water and see that it should be illegal.
Proper action of the Pure Food and Drug should make it impossible to add
sodium fluoride or any other fluorides to the drinking water or foods.
I thank you for your cooperation.
With best personal regards to you and Mrs. Hinshaw, I am
Very sincerely yours,
C. H. Carpenteb, M. D.
The following letter to the editor appeared in the Glendale, Calif.,
Independent on Sunday, April 12, 1953 :
Editor : During the past several months we have attempted to compile authen-
tic information from the most reliable sources possible regarding the dangers
of adding sodium fluoride to the public drinking water.
It is recognized by leading authorities in medicine and chemistry that sodium
fluoride is a poison to any cell structure regardless of how small an amount is
taken into the human system.
It is also recognized by leading research medical men and chemists that the
fluoride poisons are accumulative in action, that is, they tend to collect more
rapidly in the tissues than they are eliminated.
"The toxic dose for fluorine lies between 0.006 gm. (i/4 gr.) and O.Ofi gm." (1 gr.)
of sodium fluoride."
Since four gallons of water containing one part per million of sodium fluoride
contain a poison dose, how long before the accumulative action of sodium fluoride
in the system will reach this poison dose?
It is recognized by all leading authorities that some individuals have greater
ability to eliminate wastes or poisons from the system than others. Since study-
ing many sources of information, it appears that many aged individuals, as well
as those younger individuals in poor health, could quite easily collect enough of
this poison in the system through the accumulative action to result in many
types of diseases and even in death from this violent poison even though it were
present in the water in one part per million.
Fluorine ions attack the calcium of the tissues as well as that of the blood
stream, producing an insoluble calcium fluoride, weakening the structure of the
teeth as well as the bone and also weakening those structures which are built
and maintained by the calcium units of the system.
It is through the disturbance of the calcium units that the nerve tissue and
brain building become deficient and distorted, resulting in various types of
mental deficiency.
Dr. A. L. Miller (congressman) in his report on fluoridation of water states
"experimental work on rats and mice indicate a lessened mental reaction in rats
and mice who have had fluorides."
We were confident this action would take place from our previous studies
and many years of experience in biochemistry. About 2 weeks ago I discussed
points with Dr. Miller. I also discussed most of these points with Prof. H. V.
Smith of the University of Arizona about 6 weeks ago.
322 FLUORIDATION OF WATER
It must be remembei-ed that sodium fluoride has an entirely different action
in the system than the natural fluorides and that these natural fluorides have
little or no abnormal action upon the building powers of the nerve and bone
tissues while sodium fluoride interferes with the calcium metabolism through
its ionization.
These points were verified by Prof. H. V. Smith, the discoverer of the cause
of mottled teeth in those communities which had excess amounts of the natural
fluorides, substances which also are poison, but which are not as active as sodium
fluoride.
Hon. A. L. Miller, M. D., in his report to the House of Representatives on
March 24, 1952, reported "A cheek of the vital statistics of Grand Rapids, Mich. —
which is the only city of any size that has had artificial fluoridation for more
than 4 years — shows "an increase of 50 percent in the deaths from nephritis"
and "an increase of 50 percent, over a period of 4 years, in deaths from intra-
cranial lesions."
"The death rate from heart disease in the year 1944 numbered 585. Four
years later, after fluoridation had started, there were 1059 deaths." "These are
official figures contained in the vital statistics of the United States."
Dr. A. L. Miller's report also stated that sodium silico fluorides are even a
more dangerous poison than sodium fluoride, which we have mainly discussed.
The bulletin put out by the Citizens National Research Committee, Box 41048,
Los Angeles 41, gives more details about sodium fluoride and its action in the
human system.
There is no known constitutional authority for one group of people to experi-
ment upon another group of people whether the chemical used is poison or not.
If human experimentation were constitutional, then you would be as fit a
subject for experimentation as the animals.
C. H. Carpenter, M. D.,
* 1132 N. Brand Blvd.
FLUORIDATION— A NATIONAL MENACE
This pamphlet has been prepared to give factual information on the matter of
injecting sodium fluoride, a poison, in public water systems.
1. Sodium Fluoride Violent Poison. — Kills Rats Instantly
Sodium fluoride is a very dangerous poisonous chemical, a by-product of the
manufacture of aluminum from cryolite. "Sodium fluoride is a general proto-
plasmic poisoning. It is used to poison cockroaches and rats and is therefore
of toxicological interest" (1). "Fluorine is too active a substance to be han-
dled" (2).
SODIUM FLUORIDE ACCUMULATIVE IN ACTION
Sodium fluoride is accumulative in action — it tends to accumulate more rap-
idly than it is eliminated from the body. Some people are much more suscep-
tible or sensitive to this poison than others. Continuous use of water contain-
ing small amounts of sodium fluoride results in infiltration and chronic poison-
ing and hardening of body tissues.
POlSON AND LETHAL ( DEATH ) DOSE OF SODIUM FLUORIDE
"The toxio dose for fluorine lies between 0.016 gm. (^4 gi'-) and O.OG gm. (1 gr.)
of sodium fluoride. The fatal dose is thought to be approximately from 3 to 4
grams" (3). [Italic added.]
If this poison is tasteless, colorless, and odorless in water, how would you
know whether or not you were drinking a toxic or a death dose?
Four gallons of water containing one part per million of sodium fluoride con-
tain a poison dose. How long before the accumulative action of this poison
will reach this quantity?
There are many ways of ingesting sodium fluoride besides in the water you
drink, such as in foods cooked in fluoridated water, in vegetables and fruits
which have been irrigated with fluoridated water, in the milk and in the liver
of animals that drink fluoridated water, in soft drinks in which fluoridated
wated is used, also from vegetables sprayed with fluoride compounds used as
insecticides, etc.
FLUORIDATION OF WATER 323
"Autopsy findings show fatty and parenchymatous degeneration of the liver
and kidneys" (3).
"Increases of 50 percent or more in deaths from heart disease and kidney
disease in Grand Rapids, Mich., 4 years after fluoridation, suggests some possi-
J)le connection with the presence of fluorine" (4).
Fluorides
"The systemic action is no doubt due to the deprivation of the tissues of their
calcium. The mode of action is similar to that of oxalates on muscles. Fluo-
rides produce local necrosis of mucous membranes, and, after absorption, acute
and chronic poisoning characterized by gastro-intestinal upset, nutritional dis-
turbances, and degeneration of visceral organs. Fluorides are of no value
therapeutically." (3) — (Copyrighted, C. H. Carpenter, M. D., all rights re-
served.)
2. Fluorides Cause Diseased Teeth
"Mottled enamel is a diseased condition of the teeth due to the presence of
fluorine in the drinking water. There are three types of mottled enamel, the
mild, chalky white type, the more severely stained type, and the pitted, cor-
roded type. In addition, the mottled teeth are defective in formation and cal-
cification and are, therefore, structurally weak. The defect is irreparable and
permanent. It has been estimated by the Tucson Dental Society that it would
cost $1,000 for dental care of the teeth of the average person with mottled
enamel, up to adulthood, at which time the teeth must usually be replaced by
false ones.
"Drinking water contining as little as 1 p.p.m. of fluorine will cause mottled
enamel.
"Evidence indicates that the fluorine passes into the blood stream and inter-
feres with the calcification of the iinerupted teeth of children." — American
Journal of Public Health 25 :696 (June, 1935)
3. Compulsory Mass Medication of Water is Unconstitutional
Fluoridation of city water supplies constitutes a socialistic form of forced
"mass medication," violating our State laws and the Federal Constitution
according to the opinions as expressed by numerous judicial authorities and
compiled by the associate editor of the Hastings Law Journal of the University
of Californina's Hastings College of Law.
The treatise of Plastings College of Law on the subject of fluoridation holds
"that fluoridation programs are an improper exercise of a State's police power,
which includes the power to protect and promote the public health, in that they
involve an unwarranted interference with individual liberty." Tliis treatise
further states "The presence of dental caries creates no 'clear and present
danger' of an epidemic or emergency of a contagious or infectious dis-
ease * * *" (6).
4. Warning — Delaney Committee, Washington, D. C, Warns Against
Fluoridation of Water
The House of Representatives Select Committee To Investigate the Use of
Chemicals in Foods and Cosmetics warned American cities to be careful before
deciding to add fluoride to drinking water as a way of reducing tooth decay.
The warning of caution was approved by all seven committee members, and
Representative A. L. Miller, M. D. (R., Nebr.) prepared a separate report urg-
ing delay in fluoridation.
The committee report said "It is essential, therefore, that all the facts con-
cerning fluoridation be disseminated, and an opportunity given to the people of
each community to decide for themselves whether they desire to assume, at this
time, the colciilaird risk inherent in the program." The report also said "The
committee is of the view that sufficient mimher of iinavswercd questions coii-
cerninfj the safety of this program exists as to warrant a conservative atti-
tude" [Italic added.] (7).
5. Fluorine Should Not Be Confused With Chlorine
The adding of sodium fluoride to drinking water should not be confused with
the adding of chlorine which is used to help purify drinking water.
Sodium fluoride does not help purify water, but rather is a poison.
324 FLUORIDATION OF WATER
Proponents of sodium fluoridation state that chlorine is also a poison, but we
know that chlorine is not tasteless and odorless as is sodium fluoride ; there-
fore, if an excess amount of chlorine were put in the water, you would immedi-
ately reject it for drinking while if an excess of sodium fluoride were put in
the water, you would not be able to detect it.
6. Spend — Waste — Tax — Poison
99.4 percent of all public watee is used for purposes other than drinking
The city of Glendale consumes a year round average of 174 gallons per capita
per day. If every person consumed 1 gallon of water per day, only six-tenths
of 1 percent of all the water fluoridated would be used for human consumption.
The remainder would be used for watering lawns and gardens, laundry work,
bathing, washing cars, industrial uses, etc.
The proponents of water fluoridation claim that it is effective only to chil-
dren up to 12 years of age. Therefore, the treated water which would be used
by them would be less than one-tenth of 1 percent.
There are many ways that children consume liquid, such as milk, soft drinks,
and bottled water. If parents wish to have their children used as human guinea
pigs, there are many economical ways of treating their drinking water than
to put it into a system where 99.4 percent is used for other purposes than
drinking.
The proponents of fluoridation recommend that the content of sodium fluoride
be reduced in hot weather since human consumption of water increases as the
temperature rises. With the reservoirs that are in the Glendale water system,
it would take 7 or 8 days to flush out this system in order to reduce the fluorine
content of the water. By this time thousands of people would be subjected
to an overdose of poison.
7. Fluoridation Laws Violate Religious Freedom Guaranteed by the
Constitution
Fluoridation of public water supplies is not only the beginning of inroads in
socialized medicine, but is the beginning of the destruction of religious freedom.
Quoting from Hastings Law Journal, we read "Freedom to maintain and
practice the belief that medication is not to be taken is protected by the 14th
amendment. Freedom to exercise this belief is guaranteed so long as it
does not present a 'clear and present danger' to the health of the public * • *"
(6).
According to California law State health authorities are empowered to per-
mit fluoridated water to be bottled for those who desire to have it as medication.
8. Use of Sodium Flltoride Results in Fluorosis and Other Diseases
SODIUM fluoride INTERFERES WITH CALCIUM METABOLISM RESULTING IN DISEASE
Sodium fluoride interferes with calcium metabolism, the fluorine ions unite
with calcium to form insoluble calcium fluoride which infiltrates the tissues
resulting in fluorosis (abnormal hardening of the teeth and mottling of teeth),
osteosclerosis (abnormal hardening of the bone), and osteomalacia (a disease
where bones become flexible and brittle leading to deformities). "It is attended
with rheumatic pains ; the patient becomes weak and dies from exhaustion. It
occurs chiefly in adults and is due to calcium-phosphorous deficiency" (8).
The interference with calcium metabolism not only predisposes to other bone
diseases, but also predisposes to practically every known disease (in other
words, it causes a person to be more susceptible to disease), the severity of which
would depend upon the age of the individual, the general state of health of
the individual, and the quantity of sodium fluoride consumed.
9. Danger — Mechanical Failures or Human Error Might Destroy the
Community
The promoters of the scheme tell us that there can be no mechanical failure in
the machines that feed the fluorides to the water supplies. However, common
sense teaches us that man never made a machine that can't fail at some time
or other. The mechanical device could fail and over-dope the water, thus
undermining the health or killing all the people in the community.
FLUORIDATION OF WATER 32£
\
Are you going to stake your life on the supposition tliat a machine will never
fail?
Also, one man operating the machine could hold your life in his hands. In
case of human error, whether the result of negligence, alcoholic influence, or
sudden mental disturbance, an entire community could be poisoned.
Do we want to trust our lives to the recognized imperfections of the best
machines along with the element of human error ?
10. A Ready Weapon for Saboteurs
Large stockpiles of fluorides at the reservoirs of water supplies in any com-
munity would provide the perfect weapon for saboteurs. An enemy could
dump the poison into the water supplies and destroy all the people in the
community.
Sodium fluoride in water is tasteless and colorless and odorless. The damage
would be done before it was detected. The fluoride compounds are usually
added to the water at the beginning of the distribution system. This would
make it easy for an enemy to contaminate the entire supply.
An excess of sodium fluoride added to water supplies could wipe out entire
communities with greater effectiveness than the atomic bomb — leaving our
buildings and resources intact to be taken over by an enemy.
11. Sodium Fluoride Has an Entirely Different Action Than
THE So-Called Natural Fluoride Waters
(Copyrighted, C. H. Carpenter, M. D., all rights reserved)
AVe have been informed and presented with literature regarding the water of
Deaf Smith County, Tex. The analysis of the water indicates that the water
does not contain sodium fluoride, but rather it contains mainly the fluorides of
calcium and phosphorus. These compounds are almost insoluble and therefore
do not ionize readily like sodium fluoride.
Sodium fluoride in solution as in water ionizes into sodium ions (Na+) and
fluorine ions (F~). The fluorine ions unite with calcium upon contact with it.
It is the fluorine ions which attacks the calcium in the body tissues and fluids
to form an insoluble calcium fluoride which cannot be utilized by the human
economy.
Free calcium is normally transformed into living units of calcium which have
certain and very important physiological functions to perform in the human sys-
tem. It is the interference with the calcium metabolism which causes sodium
fluoride to be much more dangerous to the human system than the fluorides of
calcium, phosphorus, or other similar fluorides.
As a result of the sodium fluoride ionization, a major portion of the body chem-
istry is involved when the fluorine ions are present even in small amounts in
the human system. The degree of involvement of the human system would be
dependent upon the concentration of the sodium fluoride taken into the system,
the quantity consumed, the accumulative action (chronic poisoning), and the
age and vitality of the individual.
Since normal calcium units are a very important factor in building nerve, mus-
cle, and bone tissues, the fluorine ions, by attackini;' the calcium in the system,
interfere with normal bone growth and development, strength, nerve stability
and the mental capacity of those taking sodium fluoride into their systems.
Sodium fluoride as such would not be expected to exist in waters containing
natural fluorides and calcium, because, should sodium fliioride get into the
underground water, it would quickly dissolve and would ionize and the fluorine
ions would attack the free calcium present in most natural waters and form the
insoluble calcium fluoride.
Calcium fluoride in natural fluoride waters, when taken into the system, would
only tend to infiltrate the teeth and Haversian canals of the bones and other
tissues, resulting in abnormal hardening and interference with normal nourish-
ment of those parts so involved. This action would be in proportion to the total
amount ingested.
The natural fluoride waters can produce chronic poisoning and disease as evi-
denced in St. David, Ariz., "a community in which all the native inhabitants
have typical mottled teeth" (9), one of the manifestations of chronic poisoning.
Large sums of money are being spent in order to remove the natural fluorides
from the waters of some communities so that the people will not become chron-
ically poisoned.
326 FLUORIDATION OF WATER
However, the so-called natural fluoride waters have far less tendency to inter-
fere with calcium metabolism because of their insolubility and relative lack of
ionization ; therefore, there would be a relative lack of fluorine ions which could
attack the calcium within the system. Without interference with the calcium,
the calcium units in the system would continue to build nerve, muscle, and bone
tissue and therefore there would be little tendency to nerve or mental disturbance
from the use of natural fluoride waters.
On March 1, 1953, Professor H. V. Smith of the University of Arizona stated
that some of their m.ost intelligent students in the university come from areas
where there are natural fluoride waters. This shows that the natural fluorides
do not interfere with brain capacity, at least to any great extent, in those qualified
to attend college.
The proponents of sodium fluoridation are confusing the people by using as
examples individuals w^ho have lived in areas where there are natural fluorides
of calcium and phosphorus — where the people did not become mentally or physi-
cally underdeveloped. Those proponents of sodium fluoridation of our waters do
not inform the public of the entirely different action of sodium fluoride (which
they are recommending to be added to our water) than that of the natural fluo-
rides.
LikeAvise, as evidenced by the experimentation at the University of Arizona,
sodium fluoride stunts the growth of the rats. Natural fluorides do not seem to
interfere with the bone development of individuals, other than the resultant
inflltration of the body tissues and their abnormal hardening.
Since both of these structures (nerve and bone) are built by the same calcium
units, it indicates that the natural fluorides do not interfere with calcium metab-
olism, while sodium fluoride has been definitely proven to so interfere.
Now it is becoming quite clear than sodium fluoride could be used to control
the mental capacity of all individuals brought under its influence. Is this what
conspirators are trying to do to the American people through the city water sup-
plies as reported by Princess Ileana? (C. H. C.)
12. Fluorides Are Inorganic
Organic means "arising from an organism ; pertaining to a substance derived
from a living organism." (8) .
Organism means "any organized body of living economy ; any individual ani-
mal or plant."
"Organic chemistry" is that "branch of medicine which deals with substances
that contain carbon." (8).
The following quotation indicates that the fluorine ions of sodium fluoride
transform the bone substance from an organic to an inorganic substance by
removing the carbon.
"The method proposed herein depends upon the aflinity of bone for fluorine
which was first noted in 1893 by Carnot (9). Chemical analysis microscopic
10, 11, 12, 13, 14 and X-ray refraction examinations indicate that bone is a car-
bonate apatite with the probable formula of (Ca3(P04)2)>^•CaC03 in which
n=2 or 3. It is logical to believe that fluorine may replace the carbonate radi-
cal with the formation of fluorapatite. The completeness of this replacement
would depend on the contact with fluorine." (9).
0rga>Mc substances must contain carbon. (C. H. C.)
13. Fluorides Are Abnormal to Plant and Animal Life
Fluorides are protoplasmic poisons ; therefore, they are poisons to the sub-
stance of the cell structures of the body and therefore cannot be a normal con-
stituent 01 he organic substance of the cells.
When fluorides attack any normal cell substance, that substance becomes an
abnormal or pathological substance within the system, whether it be in the teeth,
bones, liver, or other structures.
Do not be misled by those individuals who call any fluoride found in plant or
animal tissues an organic fluoride. Fluorides are foreign elements to living
substances (plant and animal) and are there by reason of infiltration — much
the same as a nail may be foimd in a cement block, but that does not make a
nail a normal constituent of cement blocks. Having Commimists in a com-
munity does not mean that we must have Communists as a component part of
a community in order for it to be a community.
FLUORIDATION OF WATER 327
Fluorides are inorganic. Fluorine is a halogen. Halogens are dependent upon
moisture or water for their activity. Sodium fluoride dissolves in water and
ionizes into sodium and fluorine ions. When fluorine ions unite with another
element, thev tenaciously hold on t<j it. It is one of the most active chemical
elements. (C. H. C.)
14. Fluorine Ions Distort Body Chemistry
AVe must bear in mind that fluorine, its compounds, and ions are just as active
and poison today as they ever were. It is also important to realize that the
fluorides produce a wide variety of influences in the human system which could
be numbered into the thousands and that the various distortions and deficiencies
in the body chemistry brought about through its tenacious action on the ele-
ments within the human system are so many and varied that an individual
consuming this violent poison, even in small amounts, becomes correspondingly
distorted and deficient in his or her body chemistry. A deficient and distorted
biochemistry produces abnormal or pathological physiology. Thus we see that
a poison such as sodium fluoride (which is capable of producing such a wide
variety of disturbances in the biochemistry of the system) would tend to make
a person more susceptible to every known disease, including mental and physical
development and including interference with normal mental faculties, especially
if slightly more sodium fluoride were added tlian that which has been recom-
mended. (C. H. C.)
15. Inherited Tendencies
As far as tooth decay (dental caries) is concerned, that is mainly dependent
upon inherited tendencies. Almost every person, especially those past 35 or 40
years of age, have had the opportunity to observe the marked differences in
dental decay in children of the same family eating the same foods and drinking
the same milk and water.
It is now recognized that, if the parents of a child were pliysically active the
year before the child was boi-n and if the parents were not under an abnormal
amount of nerve strain during that period, the child tends to be strong with good
nerves, muscles, and bones. The same basic factors responsible for building the
bones are also responsible for building the teeth.
Strong teeth are more resistant to decay. Young people or children with good
inherited tendencies who keep active and have a good balanced diet (and with
no fluorides in the water) would tend to have strong teeth.
Even though a person inherited good tendencies to develop and maintain good
teeth, his tendency may be changed if the proper materials are not present in his
diet. A general mixed diet containing a sufficient amount of organic food ele-
ments secured from the animal and plant kingdoms must be supplied to the
system in order to maintain the necessary building materials and the proper
building powers. This building power is a normal physiological process which
takes place in areas where there are no fluorides in the water.
Good inherited tendencies, proper foods, pure and unadulterated water, and
proper physical activities tend to maintain strong, healthy teeth as well as
healthy structures of the body generally.
NO GROUP OF PEOPLE HAVE A CONSTITUTIONAL RIGHT TO EXPERIMENT UPON
ANOTHER GROUP OF PEOPLE
(Copyright, C. H. Carpenter, M. D., all rlglits reserved)
1. Handbook of Materia Medica, Toxicology and pharmacology — Davison, 4th
edition.
2. Text-book of Materia Medica, Therapeutics and pharmacology — Butler, 5th
edition.
3. Synopsis of Materia Medica, Toxicology and pharmacology — Davison, 3d
edition.
4. Newsletter, February 19-53, Public Improvement Committee, care of the
Chicago Association of Commerce and Industry.
5. American .Journal of Public Health 25 : G96 (Tune 1935) .
6. University of California's Hastings Law College article, the Los Angeles
Daily Journal, April 21. 19.52.
7. Report No. 2500. House of Representatives, 82d Congress, second session.
8. The American Illustrated Medical Dictionary, Dorland, 11th edition.
328 FLUORIDATION OF WATER
9. Bone Contact Removes Fluorine, by H. V, and Margaret Commack Smith,
Arizona Agricultural Experiment Station.
10. "Hendricks, S. B., Hill, W. L., Jacob, K. D., and Jefferson, M. E., Struc-
tural characteristics of apatite-like substances, and composition of phosphate
rock aijd bone as determined by microscopical and X-ray diffraction examina-
tions. Industrial and Engineering Chemistry, vol. 23, page 1413, 1932."
11. "Cassman, Z., The Artificial Preparation of the Main Constituent of Bones
and Teeth . Zeit Physiol. Chemi., vol. 177, page 62, 1928."
12. "Kramer, B., and Shear, M. J., Composition of bone, Journal of Biological
Chemistry, vol. 79, page 147, 1928."
13. "Bogert, L. J., and Hastings, A. B., The calcium salts of bone. Journal of
Biological Chemistry, vol. 94, page 473, 1931-32."
14. "Boissevain, C. H., and Drea, W. F., Spectroscopic determination of flu-
orine in bones, teeth, and other organs, in relation to fluorine in drinking water,
Journal of Dental Research, vol. 13, page 495, 1933."
Citizens National Research Committee
P. O. Box 41048, T.OS Angeles 41, Calif.
Mr, Harris. Mr. Chairman.
Mr. Hale. Mr. Harris.
Mr. Harris. Mr. Chairman, I should like to submit for the record
a letter in the form of a statement from Dr. R. L. Smith, Jr., secretary-
treasurer, Central District Dental Society of the Arkansas State Den-
tal Association, Little Rock, Ark., and a copy of the resolution which
was adopted on this subject.
Mr. Hale. Without objection, it is so ordered.
(The letter and resolution referred to are as follows :)
Central District Dental Society,
Little Rock, Ark., May 20, 195^.
Hon. Oren Harris,
Chairman, Committee on Interstate and Foreign Commerce,
House of Representatives, Washinffton, D. C.
Dear Sir: The disease of highest incidence known to man is dental decay.
Dental decay is rampant amongst our population, especially in our youth. The
best weapon yet found against this disease is the fluoridation of water supplies
Diligent and thorough research and study by the dental and allied professions
throughout the years have proved this fact.
In our State of Arkansas there originated a part of the original investigation
in the role that fluorine plays in reducnig dental caries. The incidence of caries,
especially in the young people of our state, is extremely high. Since there are
not enough dentists in our state to adequately control the ravages of this disease,
we immediately utilized this weapon to aid us in our unending war against
dental disease.
There are, at the present time, 13 communities in Arkansas that have flu-
oridated water supplies serving approximately 210,000 people, or one-third of
the people who are on communal water systems. More and more cities every
year are converting to fluoridated water systems.
In view of the above facts, we strongly request unfavorable report on H. R.
2341 and urge its defeat by the Congress. We also request that this letter be
filed as a part of the record of the hearings on this bill. Let us keep the best
weapon against dental caries ever found — fluoridation of community water sup-
plies.
Sincerely,
R. L. Smith, Jr., D. D. S.,
Secretary Treasurer.
Resolution of Central District Dental Society
May 19, 1954.
WHEREAS, the dental profession in the United States has recommended the
fluoridation of public water supplies as a safe and effective procedure for reduc-
ing the incidence of dental caries, and
FLUORIDATION OF WATER 329
WHEREAS, this recommendation has been based on an accumulation of many
years of careful study and research by competent individuals and groups, and
all scientific findings substantiate the effectiveness and safety of fluoridation
under properly controlled conditions, and
WHEREAS, every major national health organization including the United
States Public Health Service has gone on record favoring the fluoridation of com-
munity vpater supplies, and
WHEREAS, the passage of House Resolution Number 2341 would be a repudia-
tion of all the scientific study and research supporting fluoridation of water
supplies, and
WHEREAS, the passage of this bill would deprive the citizens of this United
States of their rightful opportunity to improve the nation's future dental health,
therefore be it
RESOLVED, That we, the undersigned members of Central District Dental
Society, State of Arkansas, urge that the Interstate and Foreign Commerce
Committee render an unfavorable report on the hearing on House Resolution
Number 2341, to recommend the defeat of this bill, and to file this resolution for
record as part of the hearings.
Mr. Hale. Dr. John Knutson, Chief Dental Officer, Public Health
Service.
Dr. Knutson. Mr. Chairman, I would like to ask your permission
to have the Public Health Service testify, present its testimony as a
unit. That will include Dr. Zipkin and Dr. Leone. I mention this
because if it is presented as a unit, as I request, it will take about 35
to 40 minutes.
Mr. Hale, You want to present your testimony as a unit?
Dr. Knutson. The three of us together.
Mr. Hale. The three together.
Dr. Knutson. Yes, sir.
Mr. Hale. That is the intention of the committee. We intended to
hear you first, then Dr. Leone, then Dr. Zipkin.
Dr. Knutson. I would like to have their testimony integrated into
my testimony, with their permission.
Mr. Hale. The Committee has in mind sitting until about 12 : 30.
Dr. Knutson. Might I suggest that you pass us over until after
lunch, then, if you want to hear one or two of the others.
Mr. Hale. Very well.
Major Robert AV. Hobson, office of the Surgeon General, United
States Army.
He is not in your group?
Dr. Knutson. Mr. Harris is here, and he would like very much to
go on now.
Mr. Hale. Mr. Harris, of Grand Rapids.
Dr. Knutson. And Mr. Welsh.
Mr. Hale. Very well, we will hear them at this time.
Mr. Harris, we will hear you.
STATEMENT OF WILLIAM LESLIE HARRIS, SUPERINTENDENT OF
THE WATER DEPARTMENT, CITY OF GRAND RAPIDS, MICH.
Mr. William L. Harris. Mr. Chairman and gentlemen of the com-
mittee, I am William Leslie Harris, superintendent of the water de-
partment, city of Grand Rapids, Mich. In 1929, 1 was gi*aduated by
Albion College, Albion, Mich, with an A. B. degree with majors in
mathematics and chemistry. Ever since that time I have been em-
ployed by the City of Grand Rapids and except for a very recent ap-
330 FLUORIDATION OF WATER
pointment to my present position my work assignment has dealt with
water treatment practice.
That assignment tlierefore, covered approximately 25 years, first
as chemist and later in 1940 as water treatment plant supervisor. I
have given lectures on fluoridation practice at in-service training
courses held at the University of Michigan and at Michigan State
College.
In 1947 I was awarded the George W. Fuller award by the Amer-
ican Water Works Association in recognition of the pioneering work
on fluoridation. The citation in parts is as follows, quoted :
In recognition of . . . his resourcefulness in instituting fluoride treatment of
a public water supply for the control of dental decay.
At the present time I am chairman of the American Water Works
Association committee E 5.10 fluoridation materials and methods.
A public water supply must be operated at all times in such a man-
ner that it will provide adequate water service, furnish protection to
property and preserve the public health. It is obvious that the pri-
mary purpose of a water treatment plant is concerned with the pre-
servation of health and that the other phases of water supply are-
matters of supply and distribution.
My work for the past 25 years has been that of a specialist in the
public health field. As such, it has been my duty to guard the health
of the commitnity I serve and to keep abreast of any developments
in the field which would enable a higher safety factor to contribute-
toward an improved well being of the citizens. The actual plant super-
vision has required a knowledge of chemistry, hydraulics, bacteriology,,
and mechanics.
The relationship of the fluoride content of a water supply to dental
health has been of great and growing interest to the water works pro-
fession for more than 20 years. In 1933 a method of fluoride deter-
mination was published by Dr. Elias Elvove, of the United States
Public Health Service.
This was the first procedure wdiich came to our attention for the
determination of the minute amount of fluoride which occurs naturally
in some waters of this and other countries. The use of this test and
improved methods which folowecl indicated that fluoride-bearing wat-
ers were usually underground supplies and that the surface water
supplies of the Midwest were essentially devoid of any fluoride.
In 1944 I was consulted by members of the Michigan Department
of Health in regards to the feasibility of adding fluoride compound
to a communal water supply to maintain a concentration of one ten-
thousandth of 1 ]:)ercent fluoride.
The interest of the Michigan department in such a procedure, which
they felt w^ould greatly improve dental health, was not explored until
after an opinion was obtained in regards tot he legal responsibilities
by the attorney general of the State of Michigan. A consideration of
the technical aspects involved in the application of a fluoride com-
pound ot the city water supply indicated that there was no unusual
problem involved and that safe and dependable procedures were avail-
able.
Mr. Priest. Mr. Chairman.
Mr. Hale. Mr. Priest.
Mr. Priest. May I interrupt you there ?
FLUORIDATION OF WATER 331
Mr. William L. Harris. Yes.
Mr. Priest. It would help me a great deal if I may know, as you
proceed, whether one ten thousandth of 1 percent is substantially one
part per million.
Mr. William L. Harris. That is one part per million.
Mr. Priest. Thank you.
Mr. William L. Harris. For in the course of water treatment prac-
tice there are at least 30 different chemical agents which are used in
amounts varying from the small amount identical with fluoride appli-
cation to quantities a hundred times or more greater.
As a guide in my consideration I had the records of the natural
fluoride content of certain waters of the United States. In some in-
stances the fluoride content of these supplies exceeded the proposed
application by a factor of more than 10 to 1 and yet there was no in-
stance of an untoward effect by the occasional use of such water by an
individual nor any ill effect even by continuous use by those whose
permanent teeth were fully erupted. A variance 10 times greater than
the prescribed dosage was not considered possible in water treatment
practice and so a completely safe operating range for fluoridation
existed.
Flouridation of the Grand Kapids Avater supply started January 25,
1945, %vith the expressed purpose of maintaining a fluoride content of
between 1.0 and 1.2 parts per million. It has been functioning ever
since with a minimum of mechanical difficulty and with complete safety
to the public and the operators of the water treatment plant.
The source of the fluoride ion at our installation has been sodimn
ffuoride but several other fluoride compounds are also available for this
purpose. In any case, the nature of the fluoride ion itself is not changed
by its separation from the natural condition in which it existed in the
ground and, therefore, it can have no effect other than that which it
would impart naturally.
The tw^o pieces of chemical feed equipment used by us for fluorida-
tion are standard items which might well be used for any of several
other water treatment chemicals. Each is e({uipped with regular dust
removal apparatus which discharges filtered air to the outside of the
building. The machines are equipped to feed a continuing amount of
fluoride which is controlled by a loss in weight device so arranged that
once the operator has set the amount to be applied per hour, no fur-
ther manual adjustment is needed.
If the machine develops operating difficulty it signals for attention
by the operator. Additional safety factors are invoked in the instal-
lation by limiting the amount of chemical which may be added to the
hopper of the machine and by a mechnical limitation of the feed rate
of the equipment. At the present time the average amount of sodium
fluoride used is 600 pounds per day or 25 pounds per hour. The abso-
lute maximum of the two machines is 100 pounds per hour (50 pounds
for each machine) so that at most the dose could not be made to exceed
four times the amount required.
If such a condition were made to exist then the limited size hoppers
would soon be emptied. But if for a moment we consider that such
a concentration (which is still safe) was developed for an extended
period of hours it would still be reduced by later mixing with water
of a lower content which had either preceded or followed it. There-
48391 — 54 — —22
332 FLUORIDATION OF WATER
fore, I do not consider it possible to significantly^ overdoes our water
supply with a fluoride-bearing compound.
It has been my privilege to visit other fluoride installations and at no
time have I witnessed any condition which might endanger the public
health. As chairman of the aforementioned water works committee
on fluoridation materials and methods I was able recently to examine
the tabulated results of a survey of operating conditions in 51 fluori-
dation installations spread across the Nation. In no instance did I find
any condition indicated which was other than safe.
Because we niade the first, and had for some time the largest fluori-
dation installation, our plant has been visited by technical and pro-
fessional men from all parts of the globe. These visitors have left the
wat^r treatment plant with expressions of surprise at the simplicity of
the installation and high regard for its safety.
One of the most recent visits was by the British Fluoridation Mis-
sion and while their investigation at Grand Rapids was only a small
part of their thorough study of the matter it is nevertheless worthy of
mention that they returned to England and made a favorable report
on their findings.
Daily analyses are made on samples of treated water collected both
in the plant and out on the distribution system. A copy of a typical
report covering the month of January 1954, is included with this
statement. Undoubtedly the results thereon are as near to a constant
figure as tests would be on a fluoride-bearing waterwell installation.
It will be noted that column 5 showing the amounts of fluoride
applied varies but four hundredths of a part per million from maxi-
mum to minimum. Columns 7 through 14 give the laboratory results
of analyses on various samples of treated water. In all instances the
findings are well below the limit of 1.5 parts per million of fluoride
set by the United States Public Health Service and it must be kept
in mind that the determination of this limit evolved from consideration
of continuous use of the supply.
These tests now constitute a daily record for each and every day
since the inception in January 1945. The consistent results contained
in this record stand as proof of the original tenant when fluorida-
tion was first considered, namely, that from a water treatment view-
point it is a safe and orthodox procedure.
(The table above referred to is as follows:)
FLUORIDATION OF WATER
Fluoride application, Orand Rapids, Mich., January 1954
333
0
_o
"3
bO
O
S
a
3
PU
(2)
Sodium
fluoride
1
a
1
ll
a
a
o
o
3
E
(5)
1.02
1.01
1.00
1.00
1.01
1.00
1.01
1.00
1.01
1.00
1.00
1.00
1.03
1.00
1.01
1.00
1.00
1.00
1.00
1.01
1.00
.99
1.00
1.01
1.01
1.00
1.00
1.01
1.00
1.00
1.00
Chemical analyses (parts
per million) fluoride
a
1
>
a
(3)
•a
3
r3
C
3
o
P^
(4)
CO
a
(6)
Is
;^
O
(7)
Distribution system
Day of month
(1)
High pressure
Low pressure
a
a
a
E
(8)
o
03 >>
(9)
a
O
a, >
(10)
bJO
.g
S
o
(11)
1
1
(12)
(13)
a
o
CD >
■<}<
(14)
1
21. 269
20.000
20. 000
24. 485
30. 740
30. 402
24. 758
34. 500
28. 529
23.800
23.800
30. 690
35. 100
35. 100
30. 506
23. 800
21. 265
20. 000
33. 798
34. 300
34. 300
29. 327
26. 600
22. 381
25. 194
26. 800
26. 800
32. 046
31. 433
26. 600
23. 950
48, 223
47, 832
47, 442
46, 966
46, 365
45, 772
45, 288
44, 615
44, 056
43, 594
43, 131
42,534
41, 850
41,166
40, 570
40, 106
39, 693
> 69, 304
68,644
67, 971
67, 302
66, 737
66, 219
65, 781
65, 288
64, 765
64, 242
63, 616
63, 004
62, 486
62, 020
420
391
390
476
COl
593
484
673
559
462
463
597
684
684
596
464
413
389
660
673
669
565
518
438
493
.523
.523
626
612
518
466
0.12
.03
.07
.08
.06
.03
.03
.08
.04
.12
.11
.06
.05
.05
.04
.04
.04
.07
.07
.05
.06
.06
.08
.06
.09
.12
.07
.08
.09
.10
.05
1.01
1.08
1.02
1.07
1.08
1.14
1.08
1.07
1.05
1.09
1.05
1.09
1.08
1.05
1.06
1.07
1.09
1.08
1.07
1.14
1.11
1.11
1.12
1.12
1.15
1.11
1.11
1.09
1.08
1.10
1.09
2
3
4
1.07
1.11
1.08
1.12
1.10
1.08
1.10
1.11
1.12
1.09
1.04
1.08
1.11
1.01
1.14
5
6
1.10
1.06
1.07
1.01
1.15
1.13
7
8
..
9
10
11 _
1.04
1.13
1.02
1.13
1.10
1.09
1.09
1.03
1.11
1.09
.98
1.08
1.06
1.08
1.06
12 -
1.09
1.05
13
1.06
1.05
1.05
14 - -
15
1.03
16
17 .
18 -
1.10
1.19
1.13
1.13
1.19
1.14
1.11
1.14
1.10
1.11
1.05
1.07
"i.'07
1.10
i.'ig
1.08
1.08
1.07
19
20
1.12
1.11
1.15
21
22 . .
23
24
25
1.10
1.10
1.12
1.15
1.04
1.12
1.09
1.08
1.12
1.09
1.10
1.12
1.06
1.07
1.07
26 - -
1.13
1.12
1.14
1.13
27
28
29
30
31
Total.. . .
852. 273
27. 493
35. 100
20.000
26. 767
16, 623
536
684
389
523
Average
Maximum
Minimum
1.00
1.03
.99
1.00
.07
.12
.03
.06
1.11
1.19
1.02
1.09
1.10
1.14
1.03
1.09
1.09
1.12
1.06
1.12
1.07
1.11
1.05
1.11
1.07
1.14
.98
1.13
1.08
1.15
1.01
1.08
1.10
1.19
1.01
1.11
1.11
1.15
1.05
1.11
1 Received 30,000.
Note. — Table compiled by Chief Chemist \V. L. Harris.
Mr. Hale. Are there any questions ?
Mr. HiNSHAw. Mr. Chairman.
Mr. Hale. Mr. Hinshaw.
Mr. HiNSHAW. Mr. William Harris is not a qualified man in the
subject of medicine, as well as some of these other subjects and I sup-
X>ose is not qualified to testify as to any of the medical aspects of the
use of fluorine, but is superintendent of the water department of Grand
Rapids. Is that correct ?
Mr. William L. Harris. That is correct.
Mr. HiNSHAW. May I ask, Mr. Harris, whether this 25 pounds per
hour is a constant rate of input into the water system.
Mr. William L. Harris. That would be an average amount if we
were operating throughout the year, average pumping, which we are
334 FLUORIDATION OF WATER
not. The amount varies from 25 pomids, but would never be less than-
would be consistent if we were operating at that rate throughout the-
year.
Mr. HiNSHAW. On the other hand, the pumping equipment that
takes in the fluoride operates at a constant rate of flow, or does it
operate at a changing rate?
Mr. William L. Harris. It is not intermittent. However, it does
vary from one day to another. We might, perhaps, be pumping 20
million
Mr, HiNSHAw. I am speaking of during any 1 day.
Mr. William L. Harris. During any 1 day.
Mr. HiNSHAW. Yes.
Mr. William L. Harris. The local pumpage is quite regular, very
nearly a constant rate.
Mr. Hinshaw. It goes from the pump into a storage reservoir and
then out into the distribution system ; is that correct ?
Mr. William L. Harris. It goes into the reservoir from our plant
and then on into the system.
Mr. Hinshaw. Into the reservoir following the introduction of the
fluoride.
Mr. William L. Harris. Yes.
Mr, Hinshaw. So that the rate of application of fluoride is just
about in proportion to the amount of water that is introduced through
the pump ?
Mr. William L. Harris. Yes.
Mr. Hinshaw. That is all. One more question, if you please.
Where do you acquire the sodium fluoride ?
Mr. William L. Harris. We have had it delivered by several com-
panies. The latest shipment came from the Blockson Chemical Co.,
Joliet, 111,
]\Ir, Hinshaw, Are they the prime suppliers of sodium fluoride ?
]Mr. William L, Harris. Yes.
Mr. Hinshaw. That is all.
Mr. Derounian. Mr, Chairman.
Mr, Hale, Mr, Derounian,
Mr, Derounian, Mr, Harris, do you know of your own knowledge
whether or not since the fluoridation of the water has been in effect in
your city that any deaths have resulted from it directly or indirectly,
traceable to that?
Mr, William L, Harris, No; I believe that tlie statistics will bear
out that there has been no effect in the change from the water supply.
Mr. Derounian, I think someone in favor of this bill yesterday
testified regarding the flaunting of public will, by claiming, if I am not
mistaken, that in Grand Rapicls they foisted this fluoridation on the
public 6 years before the public voted on it, I think they said that it
was publicly approved in 1944, yet it had been in effect since 1939. You
have been in a position to know whether that is true or not ?
Mr. William L. Harris, Yes ; I have been with the city of Grand
Kapids since 1929 and I know definitely we were not approached about
this matter until 1944 and in July 1944, the Grand Rapids city com-
mission voted to enter into the study with four other groups: The
United States Public Health Service, the Michigan Department of
Health, and the University of Michigan dental school, and it required
FLUORIDATION OF WATER 335
:aboiit 6 months for lis to get together the equipment and to start the
actual application.
Mr. Derouxiax. From yonr own knowledge, have you seen any
results of tests as to the etfects on the teeth of children and the adults
■over a sustained period where they have made these studies?
Mr. William L. Harris. You mean in the reduction of tooth decay ?
Mr. Derouxian. That is right.
Mr. William L. Harris. Those have been jDublished by the Michi-
gan Department of Health and are contained in a statement of policy
which has been issued by the INIichigan Department of Health. I
believe this statement along with some of the background has been
entered in the proceedings by our health officer.
Mr. Derounian. Thank you.
Mr. Beamer. Mr. Chairman.
Mr. Hale. Mr. Beamer.
Mr. Beamer. Mr. Harris, I would like to ask you one brief question.
The water supph^ for some cities, in some localities perhaps will have
a certain amount of fluorine in it naturally ?
Mr. William L, Harris. Yes, they all have very small traces of
fluorine. In the case of Lake Michigan water, it is seven hundredths
of one part per million and we are raising it to over one part per
million.
Mr. Beamer. I was re-reading the very able testimony of your very
able Congressman, Gerald Ford, who lives in Grand Rapids, before
our committee 2 days ago. He referred to the city of Aurora, 111.,
which I believe was indicated here had a natural amount of fluorine
in the water that Grand Rapids does not have.
]\Ir. William L. Harris. Yes.
Mr. Beamer. That is your understanding ?
Mr. William L. Harris. Yes.
Mr. Beamer. ]S'ow, across the State, only a short distance from
•Grand Rapids is Muskegon, which I understood does not have any
fluoridation.
Mr. Willia:\i L. Harris. They did not have fluoridation of their
water supply for several years.
Mr. Beamer. They do now ?
Mr. William L. Harris. They do now.
Mr. Beamer. In other words, it seems only fair from Congressman
Ford's statement — and I presume that was brought out by the citizens
of your community — that the people of Grand Rapids should have
the same privilege to avail themselves of fluoridation, if they desire
it, that the people of Aurora naturally receive from nature.
Mr. WiLLiAiM L. Harris. Yes, sir. And, of course, in Muskegon
they availed themselves of that privilege and refused to go along
further as a control for Grand Rapids. They wanted the same bene-
fit for their children that the Grand Rapids people are getting.
Mr, Beamer. Now, how much later did Muskegon do that?
Mr. William L. Harris. I do not have the date, but I would assume
that it would be about 4 years ago. They waited until definite results
were available from Grand Rapids, showing that it had reduced tooth
decay.
Mr. Beamer. I think that is all. Thank you.
Mr. Pelly. Mr. Chairman.
336 FLUORIDATION OF WATER
Mr. Hale. Mr. Pelly.
Mr. Pelley. Mr. Harris, have you had occasion to observe the effect
of this fluorine put into the water upon the pipes of the city ?
Mr. WiLLLkM L. Harris. Yes. There has been no effect on the
distribution system.
Mr. Pelly. We had evidence presented showing an advertisement,
stating that it would eat through metaL I was wondering if possibly
enoug-h time has elapsed to show the chemical reaction on the pipes
themselves.
Mr. William L. Harris. Well, this is our 10th year and there has
been no damage, corrosive condition, by any testing which we can
make. We do not expect to find any.
Mr. Pelly. Is there anything in the chemical, any chemical reaction
that occurs in the pipe which might cause an undue amount of fluorine
content in the water to suddenly occur? In other words, could it
accrunulate in the pipe and then suddenly a toxic or even a lethal dose
come out of the pipe ?
Mr. William L, Harris. No. We followed the gradual piling up
of the fluoride concentration in our water supply system immediately
after adding the fluoride at our plant. We have a rather large dis-
tribution system. It contains over 400 miles of mains. It has 3-
large reservoirs which can or could hold at that time 2 days' supply.
By the time we got the water through all that system it took about 10
days.
Nevertheless, from that time on we have alw^ays been able to find
the amount of fluoride at the end of the main, essentially the same,,
as that which we added. There was no buildup at any place.
Mr. Pelly. That is all.
Mr. Hale. Thank you very much.
STATEME1?T OF GEORGE W. WELSH, CITY MANAGER, CITY OF
GRAND RAPIDS, MICH.
Mr. Hale. Now, could we have the testimony of Mr. Welsh, the city
manager of Grand Rapids ?
Mr. Welsh. Yes, Mr. Chairman.
Mr. Hale. About how long will it take you, Mr. Welsh ?
Mr. Welsh. Five minutes.
Mr. Hale. We have just about time to hear you.
Mr. Welsh. I just wanted to supplement Mr. Harris.
Mr. Hale. We have about sufficient time to hear you before we
recess.
Mr. Welsh. And, I want to give you a little background.
Mr. Hale. You think that we sliould all drink fluoridated water!?
Mr. Welsh. I am neitlier a doctor nor a scientist. I have had
some 25 years of public service. I will give you a little background.
I served on the common council in my 10 years in the legislature;
was speaker of the house of the Michigan Legislature ; lieutenant gov-
ernor of jMichigan ; came back during the depiession and volunteered
as city manager ; later served 6 terms of 2 years each as mayor.
I was mayor when this matter was brought to us, and on the recom-
mendation of the health authorities I recommended it to the city com-
mission and, of course, have watched the progress ever since that time.
FLUORIDATION OF WATER 337
I think that Mr. Harris has covered the matter quite thoroughly and
I would like merely to stress what the gentleman from Tennessee (Mr.
Priest) stated.
During my term as mayor I served two terms as president of the
United States Conference of Mayors. I succeeded Mayor LaGuardia,
who served 8 years, and Mayor Kelly of Chicago, 2 years, and 1 pre-
sume most of 3'ou have had enough contact with the United States.
Conference of ^layors to know that we are rather jealous of our i)owers
in local commuiiities. I know that I would certainl}^ resent having
Congress say to the people of Grand Rapids, after 10 years of experi-
ence, that we can no longer do what we are now doing.
I think the gentleman from Tennessee (Mr. Priest) brought up a
very pertinent point. If Congress has the right to proht, obviously
it has the right to prescribe.
And, I would like to leave my testimony on just that one point.
There has been no agitation. Our people are satisfied with it. All
of the testimony that you have heard and all of the facts that can be
obtained show that it has been of benefit to our people and I know that,
from the present demand for new schools, that it certainly has not
hurt the birthrate in any way.
I think I will leave my testimony there.
Mr. HiNSHAW. Mr. Chairman.
Mr. Hale. ]\Ir. Hinshaw.
Mr. Hinshaw. I would like to ask the distinguished former lieu-
tenant governor of Michigan what the obvious benefits from this
fluoridation are. I think that is of great interest to the committee.
Mr. Welsh. I think you have had the testimony of these gentle-
men, the scientists and the doctors. Our people are satisfied with it.
Mr. Hinshaw. Have you had a noticeable decrease in the rate of
dental caries among children and adults ^
Mr. Welsh. I am so informed that that is the case and I am also
informed from statistics that there has been no harmful results.
There has been no increase in other categories of death rates.
Somebody asked the question about the birthrate. I know that it
has not affected us. If it has, it has been on the multiple side.
Mr. Hale. Mr. Welsh, may I inquire, before you started this pro-
gi-am of fluoridation, did you have any vote of the people ? I presume
there was a vote of the municipal officers who made the decision ?
Mr. Welsh. The commission, the city commission voted on it.
Mr. Hale. What kind of a city charter have you ?
Mr. Welsh. We have a commission-manager form — mayor and
commission.
Mr. Hale. How many commissioners?
Mr. Welsh. Seven commissioners and the mayor.
Mr. Hale. And the fluoridation program was started by a vote of
the seven commissioners ?
Mr. Welsh. That is right. I recommended it to the commission
on the recommendation of the Kent County Dental and Kent County
Medical Societies; the University of Michigan Dental School, the
Michigan Department of Health; the United States Public Health
Service, and our own city physician and city health officer.
Mr. Hale. Has there been any popular referendum on the issue?
Mr. Welsh. No ; there has never been any question about it.
338 FLUORIDATION OF WATER
Mr. Hale. I presume wlien each commissioner comes up for reelec-
tion, any particular voter could vote against a particular commis-
sioner because lie voted for fluoridation.
Mr. Welsh. Well, I think I am the only one left that was there
when it was inaugurated. It is 10 years ago, and as you know, public
officials come and go.
Mr. Hale. At any rate, there is no manifestation of popular dis-
pleasure ?
Mr. Welsh. It has never been an issue. I think our papers, our
healtli officials, our people in dental and health work generally are
favorable to it.
Mr. Hale. And there has been no increase as far as you know in
mortality from any other disease, common or uncommon ?
Mr. Welsh. The statistics I have seen show there has been no
increase.
I think the point Mr. Harris made was quite significant. We wanted
Muskegon, which is 35 or 40 miles away from us and also gets its water
from Lake Michigan, to be a controlled city and, after seeing our ex-
perience, they declined and insisted on getting the benefits themselves.
Mr. Hale.' Thank you.
Mr. Derounian. Mr. Chairman, just one question of Mr. Welsh with
respect to that "went." Did they "go" because they voted for fluorida-
tion?
Mr. Welsh. No, sir ; it has never been an issue.
Mr. DEROUNiAisr. That is all.
Mr. Hale. Thank you very much, ]\Ir. Welsh.
Mr. Welsh. Thank you.
Mr. Hale. This pamphlet entitled "Water Fluoridation Report of
the Committee of St. Louis Medical Societ}^" is submitted for the
record.
(The pamphlet referred to is as follows :)
[Reprinted from pp. 124 to 142 of the February 1954 Missouri Medicine]
Water Fluoridation
report of the committee of the st. louis medical society summary
1. Fluorine is an element existing widely in food and water, varying in its
concentration in the latter from traces to excessive amount. The fluoridation of
a communal water supply entails only supplementing a deficient natural con-
centration. There is no way of proving by chemical test that the element, fluo-
rine, exists in the same chemical combination in its natural concentration as
results from its addition in whatever salt of fluorine is chosen. From chemical
theory, however, and from all observed facts of its behavior, the inference is plain
that the soluble fluoride ions are equally effective at a given concentration,
however introduced.
2. There is an inverse relationship between the concentration of fluoride ion
in the water supply, whether naturally occurring or the result of the supplement,
and the incidence of dental caries. This has been proven by observation of
inhabitants of many communities and is accepted widely by those who oppose
fluoridation for reasons other than its effectiveness. The proper amount to be
added as supplement for a given community is arrived at in recognition of the
experience of dental caries in the school children, the naturally occurring con-
centration of fluoride ion in the water and the climatic conditions peculiar to that
locality which influence the intake of water. The benefit to be expected can best
be stated by members of the dental profession and local public health officials,
and will be in proportion to the prefluoridation caries experience of that com-
munity. While fluoridation importantly reduces the incidence of caries, it does
FLUORIDATIOX OF WATER 339
not completely eliminate it and does not diminish the need for adequate diet,
mouth hygiene and dental inspection at proper intervals. While fluordiation
begins to show its effects in a year or two in school children, the maximum bene-
flt is seen in those persons using fluoridated water from birth. The increased
resistance to caries extends at least into middle life, hence it is incorrect to
assert that only children are benefited by such a program.
3. At the levels of intake supplied in fluoridation programs, there is practically
no storage of fluorine except in the teeth. The ideal daily amount is about one
milligram in temperate or predominately cool climates and would be obtained by
drinking 1 quart of water containing 1 part per million of fluoride ion. Storage
elsewhere in the body has not been demonstrated with daily intakes of as much
as 3 or 4 times that amount. Storage in bone apparently occurs with daily
intakes substantially above 4 mg., though without demonstrable ill effect on
persons who have lived all their lives with a water supply containing 8 parts per
million of fluoride. A wide margin of safety is thus provided, inasmuch as
intakes of fluorine about 50 percent above the ideal dose produce very mild evi-
dences in the appearance of the teeth of such excess. These dental warnings are
detectable only by expert examination and are in no way harmful to the teeth.
There is no published record of any injury to the health of any person drinking
natural fluoridated water with a concentration as high as 8 parts per million, nor
of harmful effects at such lesser concentrations as occur naturally or are pro-
vided in fluoridation programs. No injurious effects can be found in the study of
vital statistics of all the common major diseases, including cancer, or in the sta-
tistics of maternal and newborn death rates. Experimental studies on man — the
most sensitive species — and lower animals confirm these evidences of the safety
of a fluoridation program. Physicians practicing in areas which have had fluori-
dation programs for three years or more report that their exi^erience in the
treatment of the sick does not differ from their prefluoridation practices and that
they do not forl)id the use of fluoridated water in any case.
4. The public health and water engineering practices are relatively simple.
They include selection of the most desirable compound of fluorine to be used,
provision for safety measures for handlers of such chemicals, installation of
feeding equipment and regular performance of chemical tests at various points
in the distributing system in order to regulate the desired concentration. Annual
cost in most communities has varied between 9 and 14 cents per capita.
5. An impressive roster of persons and organizations of recognized scientific
standing has endorsed the efficacy and safety of fluoridation. Over 3,000,000 per-
sons live in areas whose natural water supplies contain from 0 to 5 parts per
milli(m of fluorine. Testimony has been furnished from the physicians of 12 com-
munities with a combined population of nearly 800,000 persons who had fluori-
dation programs for from 3 to 7 years as of January 1, 1953. As of August 1,
1953, 772 communities in 43 states, including 10 major cities, have fluoridation
programs serving a total population of 14,000,000 persons. In the United States,
such widespread adoption of any program of preventive medicine, determined
upon at the local level has profound significance as to the solid merit of the
proposal.
6. Testimony in opposition to fluoridation has been expressed by a numerically
tiny minority of persons of undoubted scientific training and experience in
relevant fields. Close examination of their testimony reveals that they do not
usually question the effectiveness of the procedure but have reservations as to
possible toxic effects. They do not lay down criteria by which they would judge
a fluoridation program to be any safter than it has already been shown to be.
In requiring an indefinite prolongation of presently established programs before
extension to other areas they tend to disregard what has already been learned.
There is also an active, proselyting opposition that does not represent an objec-
tive, scientific point of view at all. It seeks to defeat proposals for fluoridation
by the circulation of pamphlets containing obsolete or discredited or irrelevant
charges ranging from "Operation Rat Poison" to "communistic plot" themes, with
a measure of food faddism for good measure. There is no authoritative expres-
sion of opposition from any religious sect nor from the representatives of any
school of healing the sick which is recognized by law in Missouri.
7. There are no practicable alternatives to fluoridation of water in a city such
as St. Louis. The provision of fluorine intake through tablets, milk, salt or
other means has profound disadvantages peculiar to each one. Topical fluoride
application directly to the teeth by skilled personnel cannot be applied univer-
sally as a public-health measure for the prevention of dental caries, insofar as
it is effective, due to lack of personnel and funds. While somewhat less effective
340 FLUORIDATION OF WATER
than fluoridation of the water siipply, it has merit as an alternative public health
measure in small communities without such a common source of water.
8. The use of water containing the recommended concentration of fluorine has
been shown to be without hazard in the industrial use of water. There is testi-
mony to this effect by research chemists of the associations of brewers, bakers,
and bottlers as well as by use of naturally fluoridated waters in earlier times
without dissatisfaction. Such fears as have occasionally been expressed have
not been documented and appear to be contrary to observed fact. There has
been no recorded, open opposition to this measure of preventive medicine from
any industry, nor is any to be anticipated in the future.
9. The power of a municipality, acting through its elected representatives, to
initiate fluoridation of its water supply by legislative action has been upheld
wherever challenged in court. Such a procedure is held to be proper exercise
of police power of a community to conserve or improve the health of its residents.
A fluoridation program does not treat caries already present. It is effective in
increasing the resistance of the developing tooth to the occurrence of caries.
"Preventive medicine" is an obviously more accurate description of its purpose
and effect than is "Mass medication," usually introduced acrimoniously.
10. No other public-health measure has had more thorough study prior to
adoption than the proposal for fluoridation of the community water supply
whose natural concentration of fluorine is deflcient. The ideal concentration
of fluoride ion to be delivered at the outlets should be decided by the responsible
public officials after study of current information, particularly of climatic ef-
fects, and after such consultation with other authorities as they deem necessary.
Continued studies and periodic reporting of the caries experience of selected
groups of children, as done at present in St. Louis, together with careful scrutiny
for incipient signs of dental effects of excessive fluorine ingestion should be car-
ried out as an essential feature of such a program.
Recommendation
The members of the water fluoridation committee of the St. Louis Medical
Society unanimously recommend that the elected ofiicials of the City of St. Louis
undertake without delay the necessary legislative and administrative steps to
authorize and initiate a program to increase the content of fluorine of the munici-
pal water supply to an amount whose concentration will provide maximum re-
duction in the incidence of dental caries of the children of St. Louis commen-
surate with freedom from objectionable cosmetic effects or hazard to health of
the residents as a whole.
This recommendation is made in the conviction that such a step will contribute
the most signiflcant contribution to the public health of the community since
the enactment and implementation of the smoke abatement ordinance.
(S) Harold A. Bulger, M.D.
Raymond O. Muether, M.D.
William Baktlett, M.D., Chairman.
August 24, 1953
Study
The pathways by which the human body absorbs the fluoride ion in ideal
dosage and rids itself of all but a small fraction are well understood. It is essen-
tial that one comprehend these mechanisms for with knowledge as a founda-
tion, the facts and fallacies involved in px'ograms for the fluoridation of a water
supply lose much of their mystery for the lay student. Definition of the ideal
daily dose is the first step. In medical terms, it is the physiologic dose. As with
many other substances having valuable properties when administered in a prop-
erly prescribed daily amount, fluorine becomes a harmful, rather than a benefi-
cial agent when given in excessive, or toxic, quantities. This is equally true of
iodine, bromine and chlorine, the other members of the family of chemical sub-
stances known as the halogens. They are widely distributed in animal and
plant life and most naturally occurring water contain them in varying concen-
trations. In physiologic concentration, for example, chlorine combines with
sodium to form the largest portion of the salts in solution in the blood itself.
In a different combination and concentration, it exists as the hydrochloric acid
which is the principal chemical agent in digestion of food in the stomach ; it is
administered by mouth throughout a lifetime to patients whose own digestive
juices are deflcient. In still other concentrations and chemical combinations
chlorine is used to prevent the growth of harmful germs in water supplies and,
in murderous form, it is the principle component of war gas. Common table salt
FLUORIDATIOX OF WATER 341
is the same chemical substance as tlie sodium chloride in solution in the blood
.and tissue juices, yet excessive intalve of salt, or no intake of salt, produces grave
illnesses ; the same statement is true of excessive or inadequate intalve of water
alone, yet water malves up about 70 percent of the weight of the human body.
In considering the effects upon the human body of a given element, therefore,
one must define not only the chemical compound itself, but the concentration in
which it is to be delivered, the total daily dose and the period of time over which
it is to be administered. For the fluoride ion the ideal, or physiologic, dosage is
approximately 1 milligram (mg.) per day which is achieved by the human utili-
zation of drinking water and water used for cooking from a source containing
an average concentration of 1 part of fluoride ion per million parts of water
(1 ppm). This intake of fluoride is calculated as a proper addition to the small
amount contained in various solid foods. The needs of the body for water are
fixed by nature and, although habitual intakes of drinking water, or of sub-
stances'dissolved in water, vary widely with the individual, the differences are
not significant in altering importantly the effects upon the human body of these
small quantities of fluorine. Since few naturally occurring waters are com-
pletely free of fluorine, one should always think of a fluoridation program, not
as addition of a substance foreign to the water, but as a process of supplement-
ing an inadequate concentration. In many conniiunities in the Southwestern
States programs of defluoridation have been instituted in order to remove an
undesirable excess of fluorine and to lower its concentration, not to zero, but to
physiologic levels. It must be understood, moreover, that it makes no demon-
strable difference to the human body whether the ideal concentration of fluoride
in its water supply has been achieved naturally, by supplement or by defluorida-
tion. Whatever chemical combination of fluorine, the element, is dissolved in
water as fluoride ion and is measurable by standard tests is capable of absorp-
tion by the body (1, 2, 67) .
Fluorine is properly eoosidered to be one of the trace elements normally pres-
ent in very small amounts in the human body. Its usefulness in increasing the
resistance of the teeth to decay (dental caries) has only become obvious in recent
years and will be elaborated subsequently. In physiologic dosage, very small
amounts of fluoride are stored in the enamel of the teeth of infants and children
before hardening of the enamel is completed and particularly before the per-
manent teeth have erupted into the mouth. In physiologic dosage, storage of
fluoride ion elsewhere in the body has not been demonstrated. The remainder
is passed (excreted) from the body in the urine, sweat and feces (2, 3, 4). There
is, as yet, no other known beneficial role which such small quantities of fluorine
play in the human economy. The ideal, or physiologic, dosage of fluorine is
therefore that amoimt, in the concentration and quantity already described,
which will importantly reduce the incidence of dental caries and which will not
produce undesirable effects. In temperate climates the year-round ideal con-
centration in a water supply has previously been stated to be 1 p. p. m. The
permissible upper limit has been set as 1.5 p. p. m., (5) for with even moder-
ately higher concentrations of fluorine no considerable added protection against
dental caries is seen (6) and an undesirable cosmetic phenomena fluorosis (no-
ticeable brownish mottling of the enamel ) , begins to appear in a small percentage
of people. No documented instance of damage to health has been recorded from
the use of water containing the physiologic dosage of fluorine, whether naturally
occurring or supplemented, no matter over how long a period (4, 7, 8).
It has already been stated that variations in the total daily intake of properly
fluoridated water do not produce important alterations in physiologic effects.
This needs qualification, for seasonal concentrations should be related to the
ideal, year-round concentration of 0.0 to 1.5 p. p. m. of fluoride ion for a tem-
perate climate. Climate plays a part in determining the total fluid intake of
the population. It is important to remember that about 90 percent of the weight
of a solid, general diet lies in its water content and added liquid is drunk to make
■up the body's need for total daily water intake ; water is made available by the
body for the formation of urine only after all the other needs for water, including
the formation of sweat, has been met. In warm, humid periods of the year the
need for water is increased and it has therefore been the logical practice in
communities with a fluoridation program to reduce the amount of fluoride
added to the water supply in order to produce a concentration at the outlets of
as little as 0.6 p. p. m. xmder such climatic conditions, raising the latter to 1
p. p. m. or slightly higher during cool weather (9, 10).
342 FLUORIDATION OF WATER
Allusion has been made to the fact that with increasing concentrations of
fluoride ion cosmetically undesirable mottling of the enamel appears in increas-
ing percentages of children who have been on such an intake from infancy.
This is noticeable to the untrained observer and persists throughout the lifetime
of the individual ; no harm to the structure of the tooth is involved. Such
grossly noticeable mottling does not occur with ideal concentrations which are
appropriately adjusted downward in spells of hot weather. Under these cir-
cumstances, less than 15 percent of children at ages 12 to 14 years develop a
very faint change in color of the enamel, localized on various surfaces of the
teeth and detectable only to the trained observer using instruments and special
illumination (7). There is, therefore, no cosmetic hazard with physiologic con-
ditions of fluoridation, natural or planned.
The warning sign that the ideal daily intake is being exceeded lies precisely
in the appearance of dental fluorosis, mottling of the enamel, as concentrations
of fluoride ion in the water supply are increased. The large margin of safety is
apparent when one reviews the incontrovertible evidence that water containing
8 p. p. m. has been the only source of supply for the community of Bartlett, Tex.,
during several generations without detectable evidence of injury to health upon
searching scrutiny of the population (11). Aside from mottling of the teeth,
increased bone density in X-ray examination in 11 percent of the persons exam-
ined was the only deleterious effect found ; it was not associated with symptoms
and constituted the only way except for dental effects in which these people
were foimd to differ from the inhabitants of a neighboring community with in-
adequate amounts of fluorine in the water supply. Completely reliable data (12)
reveal that water naturally containing 1.0 to 1.5 p. p. m. is used by more than
one million people. Water containing 1.6 to 2 p. p. m. is used by more than
900,000 persons. Water containing 2.1 to 3 p. p. m. is used by more than 600,000
persons. Water containing 3.1 to 5 p. p. m. is used by more than 100,000 persons.
Water containing more than 5.1 p. p. m. is used by 40,000 persons. A total of
3,000,000 persons in the United States, then, have for many years been using
water naturally containing fluoride ion in concentrations, variously, between 0.9
and 5 p. p. m. and in none of them has an authentic case of injury to health
attributable to the fluorine concentration been reported in the vast medical
literature. The reasons why none is to be anticipated, even at these concentra-
tions of as much as five times the ideal daily dosage, will be elaborated.
Before proceeding to comment on the published studies that have demonstrated
the absence of a hazard to health in the use of water containing fluorine in con-
centrations even higher than the ideal, let us recapitulate briefly the observed'
facts presented hitherto for consideration :
1. The disci. ssion of the effects upon health of any waterborne element must
define (a) the chemical combination in which it is to be employed, (6) the total
daily dosage, (c) the concentration to which it will be diluted upon delivery at
the tap, and {d) the period over which it is to be consumed.
2. The ideal, or physiologic, daily dose of any substance is that amount which
will produce the desired beneficial effect in a reasonable percentage of instances
without doing harm.
3. The physiologic dose of the fluoride ion, judged from the point of view of
its dental effects, is approximately 1 milligram daily. This is attained in tem-
perate climates by drink water which has naturally a concentration of about 1
part per million of fluoride or to which fluorine has been added to approximate
that concentration in commimities where the water supply contains less than the
ideal amount.
4. In physiologic dosage, fluorine is not stored in the body except for that very
small amount that enters into the process of hardening the enamel of the devel-
oping teeth. The remainder is lost to the body, principally in the urine.
5. No evidence of injury to the well-being of any person, sick or well, infant
or aged, has been related to fluorine present in water in physiologic concentration.
6. The teeth of persons receiving water containing physiologic concentrations
of fluoride, properly adjusted to local climatic conditions, do not show dis-
coloration.
7. At concentrations fluoride rising above 1.5 p. p. m. visible mottling of the
teeth is observed with increasing frequency. This is undesirable from the
cosmetic viewpoint.
8. The appearance of mottling detectable only by a trained observer in more
than 10 percent of children is an indication that physiologic doses are being
exceeded.
FLUORIDATIOX OF WATER 343
9. The margin of safety with concentrations of fluoride higher than ideal is so
wide, that no sign of ill effects has been detectable by close scrutiny even of the
members of one community using a water supply containing 8 p. p. m. for several
generations. Over 3 million persons in the United States live in communities
where the natural concentration of fluoride in the respective water supplies is,
variously, from 0.9 to 5 p. p. m.- There is no medical record to show that, aside
from relative freedom from dental caries, their health differs from that of per-
sons dependent upon water containing less than ideal amounts of fluorine.
10. No distinction is to be made between the effects on the human body of
fluoride ion naturally occurring in a water supply and the same concentration
of fluoride attained by either supplementation or defluoridation.
It is not surprising that relatively few organized investigations of the health
of persons living in communities whose water supplies have a physiologic con-
centration of fluorine, either naturally or by supplement, have appeared in the
medical literature. Such inquiries into the possibly toxic effects of any sub-
stance in the natural water supply employed by a population are prompted either
by (1) reports of damage to health in individual cases or (2) the publication
of reports of laboratory studies on animals and human volunteers indicating
that the behavior of the substance in the body under applicable conditions is such
as to make it likely that evidence of injury to health in specific ways may appear
and should be sought. In the total absence of such clinical or laboratory reports
of health hazards with respect to ideally fluoridated water, few community health
departs have found themselves so plentifully supplied with the taxpayer's money
that they could divert funds and personnel to looking for troiible where none was
to be anticipated. Such an effort is a luxury, comparatively, in view of the
urgent needs and limited sums with which all departments of health and sanita-
tion are chronically faced. The conscientious and highly trained members of
Federal, State, and local public health professional associations study critically
the investigati(ms in their field and do not lightly or carelessly endorse proposals
for preventive measures whose conceivalile harm might outweigh the benefits. As
will be brought out, there is a still larger body of published evidence as to the
safety of drinking water containing higher than physiologic concentrations of
fluoride and this has been the logical field for the most intensive study of the
problem. Let us examine, then, the reports which bear on the safety to the
consumer of drinking water containing fluoride ion in concentrations of up to
approximately .5 parts per million.
The city of Newburgh, N. Y., was one of the first communities in this country
to add fiuorine (as sodium fluoride) to its natural water supply (1945) bringing
up the concentration from 0.1 ppm to 1 ppm. Systematic continuing examina-
tions of schoolchildren have been reported in respect to general physical exami-
nation, analyses of blood and urine, X-rays of the bones of the hands, forearms
and legs and special eye and ear examinations in selected samples; detailed
dental records have also been kept for comparison with the prefluoridation data
obtained in Newburgh and in neighboring Kingston, N. Y., which had a similarly
meager concentration of fiuorine and from which fluorine supplement has been
withheld for the sake of comparison. These studies have been carried out
in conjunction with the New York State Department of Public Health. As
reported in 19.50 (13) and again in 19-52, we read: "Careful examinations car-
ried on since the study started reveal absolutely no harmful effects from drink-
ing fluoridated water" (14). Herman E. Hilliboe, M. D., commissioner. New
York State Department of Health, adds "These results bear out studies made
in other areas of the country, where persons have been drinking naturally
fluoridated water all of their lives with utmost safety" (14). No differences
(other than dental) in the physical condition of the children of Newburgh and
Kingston have been found ; the dental beneflts will be reviewed separately.
The Evanston, 111., dental caries study group has also carried on regular exami-
nation of the school children since that community began to supplement (to
1 ppm) the negligible quantities of fluorine in its water supply in 1947. In a
letter (15) dated March 9, 19.53, Winston H. Tucker, M. D., commissioner of
health of Evanston, writes : "No detrimental effects of any sort have been found
in the children on careful examination. I am not aware of any evidence pub-
lished in medical literature showing that there is an increase of any disease
which (onld he attribntt'd to fluorine in a concentration of one part per million
in a public drinking water supply."
Studies on :i soniewliat older age groun bavo been made by ^rcriui'o fthen
senior biochemist. National Institutes of Health, Bethesda. Md.). He has
reported (16) observations of height and weight and the incidence of bone
344
FLUORIDATIOX OF WATER
fractures in 1,458 high school boys residing in communities whose water sup-
plies varied from zero to 1 ppm fluorine content. There is no correlation of
the fluorine content of the water with growth and development or with the-
experiences of fractures of bones, as is evident in tables I and II.
The examination of vital statistics for any community is a standard method
of finding clues as to the possible relationship between a given disease and a
suspected agent, causative, contributory or complicating. From a series of
published data (17, 18, 19, 20, 21) table III has been prepared. It demon-
strates beyond dispute the lack of any regular pattern of relationship between
death rates from all cancers and the fluoride content of the water (varying
from zero to 4.5 ppm) in several communities. In table IV is evident the sam&
lack of correlation between the periods of survival of sufferers from several
types of cancer and the fluoride content of the water in San Francisco, which
had little or no fluorine, and in Denver, which has 1.2 ppm (17, 18).
Tables V and VI (22) reveal the relationship of deaths of pregnant women
and of babies before and after birth to the fluorine content of the water in
several Wisconsin communities during 2 successive 5-year periods. The well
recognized stresses of pregnancy and the sensitiveness of the developing fetus
to changes in its environment could be expected to reflect toxicity if any such
existed in the water supply. Yet there is no important or consistent difference-
in the frequency of deaths at term (still birth), immediately after delivery
(neonatal), during the first year of life (infant) nor in the mothers them-
selves in the cities whose water supplies contain from 0.03 p. p. m. to 2.5 p. p. m. of
fluorine. Nor is there any significant altei'ation of these patterns in the city of
Sheboygan during the 5-year period following the raising of its fluoride concen-
tration from 0.03 p. p. m. to 1.2 p. p. m.
Fears are often expressed that even physiologic concentrations of water-
borne fluorine may have an adverse effect upon sufferers from certain organic
diseases. In tables VII and VIII (22) appear the vital statistics from these
same Wisconsin communities over the same successive 5-year period, 1940-44
and 194.5-49. The frequency of the following disorders are reported : health
diseases, cancer, cerebral hemorrhage (stroke), nephritis (degenerative diseases
of the kidneys), pneumonia, diabetes, tuberculosis, influenza, and appendicitis.
The utter lack of correlation between the members of deaths from any of these
diseases and the naturally occurring fluorine content of the respective municipal
water supplies is obvious, including the comparison of pre- and post-fluorida-
tion data in Sheboygan. The Commission of Public Health of Sheboygan,
G. C. Hildebrand, M. D., advises : "I am enclosing a chart giving the number
of deaths of the more common causes of death. There is nothing in our sta-
tistics in the last ten years to indicate that fluoridation has had any adverse
effects on the health of the people of this community" (23) .
Table 1.— Comparison of the height and weight of l,Jf^8 high school boys, ages 15
to 11 years, residing in cities ivith different concentrations of fluoride in public
wafer supplies — Source {16)
Qalesburg and Mon-
mouth, 111
Aurora, 111
Elgin, 111
Fluo-
rif'e
(parts
Height
Weight
per
million)
1.8
67.2
135. 6
1.2
66.7
136.5
.6
68.0
136.1
Quiney, 111
Waukegan, 111
Washington, D. C
Fluo-
ride
(parts
per
million)
0.1
.0
.0
Height
67. 2
67.4
68.4
Weight
134.2
136.8
140.0
FLUORIDATION OF WATER
345
Table II. — Comparison of bone-fracture experience of 1,458 high school boys,
ages 15 to 17 years, residing in cities with different concentrations of fluoride
iti public icater supplies — Source (16)
Total
Total
Fluorine
number
Fluorine
number
(parts per
of bone
(parts per
of bone
million)
fractures
million)
fractures
in water
per 100
boys
in water
per 100
boys
1.9
27.0
Quincv
0.1
21.3
Monmouth
1.7
1.2
31.0
25.3
Waukegan
0
0
25 0
Washington, D. C
32 4
Elgin
.5
24.3
Table III. — Comparison of cancer mortality rate per 100,000 in areas with differ-
ent concentrations of fluoride in the public water supplies — Source (19), (17),
(IS), {20) and (21).
Texas : Mortality rate
Cities having little or no fluoride (1948-49) 91
Nacogdoches ]
AbHene [Total population, 105,334
Stephensville J
Cities having 3 to 4.5 parts per million fluoride (1948-49) 81
Lamera ]
Lubbock rp^j-j^l population, 163,382
Plainview
Amarillo J
Wisconsin :
Stevens Point little or no fluoride (1945-49) 136
Population 16,550
Green Bay, 2.6 parts per million fluoride (1945-49) 131
Population 52,443
Sheboygan, population 40,638 :
Little or no fluoride (1940-44) 148
After fluoridation (1945-49) 138
Colorado, California :
San Francisco little or no fluoride 1938 151
Population 1,131,119 1947 149
Denver 1.2 parts per million fluoride 1939 137
Population 316,124 1947 132
Table IV. — Comparison of survival rates of different types of cancer 12 months
after microscopic diagnosis, expressed as percent survival — Source (17) and
(18)
Cancer, all types
Cancer of stomach
Cancer of lungs and
bronchii
San
Francisco,
little or
no fluoride
Percent
70
34
Denver 1.2
parts per
million
Percent
20
Cancer of breast
Cancer of uterus
Leukemia.
Lymphomas
San
Francisco,
little or
no fluoride
Percent
44
83
32
58
Denver 1.2
parts per
million
Percent
3»
78
38
62
346
FLUORIDATION OF WATER
Table V. — Comparison of deaths related to pregnancy in cities tvith different con-
centrations of fluoride in the public ivater supplies, IDJfO through I944 — Source
(22)
Green Bay
2.5 parts per
million
Fond du Lac
0.5 parts per
million
Sheboygan
0.03 parts per
million
Death rate (per 1 ,000 population) _ _ .
Still birth rate (per 1,000 live births)
Neonatal rate (per 1,000 live births).
9.1
22.5
25.1
12.1
20.7
22.7
10.0
24.0
22.4
Table VI. — Comparisons of death related to pregnancy in cities tvith different
concentrations of fluoride in the public water supplies, 19Jf5 through 19^9 —
Source {22)
Green Bay,
2.5 parts
per million
Stevens
Point, 0.2
parts per
million
Sheboygan,
1.2 parts
per million
Sheboygan,
0.03 parts
per million 1
Death rate (per 1,000 population)...
Stillbirth rate (per 1.000 live births)
Neonatal rate (per 1,000 live births)
Maternal rate (per 1.000 live births)
Infant rate (per 1,000 live births) ...
9.1
17.5
24.6
sae
9.0
15.0
32.0
2.6
46.4
19.1
22.7
1.1
30.8
10.0
24.1
22.4
1.7
30.9
' Before fluoridation (1940-44).
Table VII.- — Comparison of death rate of some representative diseases in cities
irith different concentrations of fluoride in the public water supplies, 1940
through 1944— Source (22)
Green Bay
2.5 ppm
Fond du Lac
0.5
Sheboygan
0.03
Leading causes of death (rates per 100,000 population):
307.6
127.2
93.9
51.0
27.7
34.6
17.7
17.7
12.5
360.9
195.5
130.8
114.7
28.7
38.2
19.8
6.6
5.1
311.0
148.1
Cerebral hemmorrhage — - -. . ..
97.9
41.3
28.5
32.5
32.5
8.4
Appendicitis
4.4
Table VIII. — Comparison of death rate of some representative diseases in cities
with different concentrations of fluoride in the public water supplies, 1945
through 1949— Source (22)
Green Bay
2.5 parts
per million
Stevens
Point
0.02 parts
per million
Sheboygan
1.2 parts
per million
Sheboygan
0.03 parts
per million '
Leading causes of death:
Heart
Cancer
Cerebral hemorrhage
Nephritis
Pneumonia
Diabetes
Tuberculosis
Influenza
Appendicitis
279.7
131.6
103.3
28.7
19.0
20.9
7.8
8.2
5.2
298.5
136. 2
77.0
32.0
33.2
34.3
14.2
2.4
3.6
340.9
137.7
124.2
21.7
23.9
24.4
19.4
4.5
2.3
311.0
148.1
97.9
41.3
28.5
32.5
32.5
8.4
4.4
' Before fluoridation (1940-44).
FLUORIDATION OF WATER
347
Table VITT. — Comparison of death rate of some representative diseases in cities
vith different concentrations of fluoride in the public ivater supplies, 19Ji5
through 19 J,9— Source (22)— Continued
TABLE IX
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
Infant death rate (per 1,000 live births).
Death rates (per 100,000 population) :
Heart disease ._
28.2
367
50
120
25.5
390
57
118
30.8
477
68
139
32.4
430
57
131
36.0
472
77
149
31.6
395
51
143
23.6
403
52
111
19.4
428
47
104
20.1
377
38
101
17.9
404
11
Intracranial lesions
150
The addition of sodium fluoride to the water supply of Grand Rapids, Michigan,
" was initiated on January 25, 1945. Only a trace (0.1 p. p. m.) of naturally
occurring fluorine was previously present in the water obtained from Lake
Michigan and the concentration is now supplemented to 1.0 p. p. m. Table IX
has been prepared from vital statistics of 1941-1950 furnished (24) by W. B.
Pro thro, M. D., Public Health Director of Grand Rapids, and sets forth the infant
death rate and the death rates due to heart disease, nephritis and intracranial
lesions (including brain tumors, strokes and other disorders arising within the
skull).
In comment. Dr. Prothro writes : "We have not observed any significant change
in the vital statistics of Grand Rapids since the inception of our fluoridation
program." Dr. C. V. Tossy, Associate Chief of the Public Health Dentistry
Section, Michigan Department of Health, remarks : "Vital statistics in Grand
Rapids have been studied in comparison with the rest of the State, and there are
no differences that could be attributed to fluoridation of the water. There have
bron no adverse effects of any kind noted" (25).
The City of Janesville, Wis., whose water supply was naturally free of fluorine,
started the addition of sodium fluoride in the proportion of 1 p. p. m. on July
20, 1948. Fred B. Welch, M. D., the City Health Commissioner, writes: "An
evaluation of our vital statistics show no adverse effects have been noted with
regard to chronic diseases of the kidneys, circulatory system or cancer and
diabetes mellitus" (26).
Additional information of value has been received in response to inquiry
directed to the president of the local medical society (27) and to the community
health officer (28), respectively, of each of 15 cities of more than 10,000 popu-
lation which has had a water fluoridation program in effect more than 3 years
(initiated before January 1, 1950). The substance of the questions to the prac-
ticing physicians is (1) "Do you notice any change in the course of certain dis-
eases since fluoridation was started?" and (2) "Do any of your local physicians
forbid the use of the fluoridated water in treating such patients?" The diseases
specified were cancer, diabetes and inflammatory or degenerative diseases of the
circulatory system and of the kidneys. The second question was repeated in
the query to the district health oflicers, along with a request for current informa-
tion on vital statistics and dental results. We failed to receive answers to these
two questions from three of the communities. The replies from 12 (15, 23, 24,
26, 29), 4 of which have been quoted verbatim, are unequivocally in the negative.
There is no dissatisfaction or concern reported among the physicians in the com-
munities in which fluoride supplement up to physiologic concentration has now
been added for from 3 to 8 years. No physician in these communities is reported
to forbid the use of water from the municipal supply and substitute water from
another source. This is not offered as scientific evidence but as proof of the
attitude of the physicians who treat the sick of these 12 cities whose total
population exceeds 785,000 persons, according to the United States census of 1950.
Returning to consideration of areas in which the natural concentration of
fluorine in water equals or exceeds the ideal figure of approximately 1 p. p. m.,
it has already been slated that more than three million persons have used such
concentrations (up to 5 p. p. m.) all their lives without reported ill effects on
health (12). It is probable that analyses in other areas will make this number
larger, as a recent report (30) from Iowa indicates that a considerable per-
centage of people in that State are using water containing physiologic, or
higher, concentrations of fluorine. Evidently, the physiologic daily dose must
48391—54-
-23
348 FLUORIDATION OF WATER
be exceeded severalfold for very prolonged periods before storage of fluorides
in bone becomes detectable to X-ray examination. This condition of "bone
fluorosis" is the next detectable sign after dental fluorosis (mottling) that ideal
intakes ai-e being grossly exceeded. Its existence has not been demonstrated in
persons receiving up to five times the amounts from natural sources or by
any artificial fluoridation program. An X-ray survey of 31 inhabitants of
Bureau, 111., residents of that community for from 18 to 68 years, and using a
water supply providing 2.;") p. p. m. of fluoride, revealed none of the hardening of
the bones that characterizes fluorosis. A study (31) by the same authors of
86 inhabitants of Kempton, 111., where the content of fluorine in water varies
from 1.5 to 3.0 p. p. m. also failed to show fluorosis of bone. At a much larger in-
take (S p. p. m.) a survey (11) already cited, was made by a team consisting of 3
physicians, 3 nurses and 1 dentist in the community of Bartlett, Tex. Com-
plete physical examinations, medical history, urinalysis, blood counts and X-raya
of l)oneVere made on everyone resident there for more than 15 years. Over
30(X) X-ravs were taken and were submitted to the specialists in two well-
known clinics for interpretation. From one consultant came the opinion that
in 12 percent of the individuals over 50 years of age in a minor degree of
change in bone structure was present but was without clinical significance.
In the neighboring town of Cameron, with three times the population, the same
stvidy was made on 1 out of 3 persons. Although the concentration of fluorine
in the water in Cameron was only 0.3 p. p. m. almost identically that of St. Louis,
no evidence was developed to show that the residents of either community were
healthier in any way than those of the other. Mottling of the teeth, of course,
was common aiid caries infrequent in the people of Bartlett, in comparison with
those living in Cameron. _ • ^ • «. ,. ^-i, *
It is outside the range of our purpose to review the chronic toxic effects that
appear with still higher intakes of fluoride. These are seen in industrial
poisoning and usually involve intakes by breathing dust-born fluoride in enor-
mously higher amounts than those defined as appropriate to a water fluorida-
tion project. It has been shown that with daily intakes up to 5 mg. of fluorine
(five times the ideal dose) excretion by urine, sweat and feces keeps up with
intake. (2) onlv a small fraction being taken up by the teeth. The concen-
tration of fluoride in the urine becomes, therefore, a good indication of the in-
take until toxic doses are reached and urinary output lags behind bone storage
of fluorine Therefore, some idea of the magnitude of the intake of those in-
dustrial workei-s who have shown X-ray evidence of bone fluorosis, both with
and without symptoms, is revealed in their average reported urinary concentra-
tion of 16 p p'm in one studv (32) and of 10 p. p. m. or more in another (83). ^,
We have therefore, examined the data submitted by direct medical study
of persons using fluorine in physiologic, or larger, concentration in the water
supply and the comparative vital statistics revealing incidence of a variety of
diseases in communities whose waters bear various concentrations of fluorine,
boUi above and below the idenl level. A third method of determining the effects
of fluorine within a restricted range of daily dosage is that involving the ex-
perimental feeding to humans and to animals. We have cited twice the study
made bv McClure (2) and Mitchell (professor of animal nutrition, TTniver-
sitv of Illinois) and coworkers. They fed to five healthy young men a diet sup-
plemented bv fluorine in various forms at difl^erent doses up to 6 mg. per day
over periods of 21 to 26 weeks. Chemical analyses of all food and fluid and of
all excreta (urine sweat, and feces) were made at intervals for fluorine con-
tent hence a most thorou-h and critical "balance study" was carried out. Four
of their important findings and conclusions will be quoted directly :
(1) "The elimination of absorbed fluorine via the urine anrl perspiration is
rracticallv complete when the quantities absorbed do not exceed 4.0 to 5 0 mg.
daiiv" C>) "The nronortion of fluorine excreted bv the kidneys fpl] during
periods of higher environmental temperature and the proportion excreted in the
^wpat vn^e under these r-ircnmshmces" (3). "There was no si£rnificant reten-
tion of fluorine in the bodies of these young adult men when total daily fluorine
in-ested did not exceed 4.0 to 5.0 mg. daily. The data suggest that these may be
the limits of fluorine which may be ingested daily without an appreciable hazard
of boflv storage of fluorine" (4). "The consistent evidence of practically com-
plete fluorine equilibrium in these human subiects would se^m to indicate also
'hat exposure to domestic waters, such as Galosburg. 111., drinking water contam-
in<- 1 « to 1 0 p p m fluorinp. or anv drinking water which contributes ^^ ^\^Jr
age of not more than 3.0 to 4.0 mg. fluorine to the ingesta (total intake of fluids
FLUORIDATION OF WATER 349
and solids) is not liable to create a public liealtli hazai-d of cuiuiilative toxic
fluorosis." Four of their live subjects were carefully examined at the end of
the study period for signs of possible injury to health. Complete physical exami-
nations, blood counts and smears, urinalysis, dental examination and X-ray of
the teeth were not revealing. There was no inflammation of the skin to indi-
cate irritation from the unusually high amounts of fluorine in the sweat.
The findings of McClure and Mitchell substantiated earlier balance studies
by Machle and Largent (3) in 1943, although the latter reported storage at total
daily intakes of G mg. Failure of Machle and Largent to measure the fluorine
content of sweat may account for such discrepancy between intake and output
at these comparatively large intakes. The results of these exhaustive balance
studies are such as to let us say with confidence that we know enough of the
means by which the body disposes of fluorine at levels of daily intake up to 5 mg.
to predict that intakes of the order of 1 mg. daily over however long a period will
not cause injury to health.
A very large body of research is reported on experimental animals fed fluorines
in various chemical combinations in a considerable dosage range. While research-,
on a member of one species cannot necessarily be applied to those of another
species (including man), certain observations as to margins of safety and varia-
tions in at)sorption of different chenfical compounds of fluorine are of intei-est,
particularly in considering certain objections to the fluoridation of water. In.
experiments on rats, Roholm (35) found that a dose of 1 mg. of fluoride ion per
kilo (2.2 pounds) daily would induce incipient mottling of the enamel; the com-
parable intake for a man weighing 154 ijounds would be 1 quart of water daily
with a concentration of 70 p. p. m. Five times this amount would cause bone
fluonxsis ; 10 times the original dose (or the equivalent of 1 quart of water
daily, with a concentration of TOO p. p. m.) regularly causes signs of ill healthy
Largent fed 65 mg. of fluorine (as sodium fluoride) daily to 2 dogs from the
age of 11 months. After 5^2 years the animals were sacrificed and no note-
worthy changes were found upon microscopic examination of the organs or
hones ; during life no changes in the bones detectable by X-ray examination devel-
oped (36). In evaluating such a repoil, one must take into account the fact
that a corresponding daily dose for a man would be enormously larger than the
1 mg. amount considered ideal for dental purposes. Similar studies have been
carried through several generations of dogs without discernible effects on their
health, yet, it must be repeated, sensitiveness of different species to the effects^
of fluorine differ sufficiently that literal application of data on dosage cannot
safely be carried over from one species to another.
Important differences in the absorption from the intestine of fluorine, depend-
ing upon the form in which it is ingested, was brought out in the publication (37)
by Greenwood in 1946. He fed fluorine in a dosage of 5 mg. per kilo (2.2 pounds )'
to puppies as sodium fluoride, as bone meal and as defluorinated phosphate. It
was noted that dental fluorosis appeared in the puppies receiving sodium fluoride,,
but not in those receiving the same quantity of fluorine in the other forms, an
indication that fluoride ion in bone metal and in defluorinated phosphate is less
readily absorbed from the intestine than is sodium fluoride. Jackson came to
the same conclusion and reported (38) his feeding experiments on immature and
adult rates, showing conclusively that the concentrations of fluorine differs con-
siderably in different bone meals and cooked bone, depending both upon their
origin and particle size. Jackson demonstrated the variability of absorption
from the intestine of fluorine in bone meals due to these and to other factors and
cited other investigations in animal and human feeding experiments to the same
point. One of McClure's (2) salient conclusions was that absorption of fluoride
sujiplements is largely dependent upon their solubility (i. e., upon the ease with
which they dissolve in water or in digestive juices). As might be expected, in
i\lc( 'lure's balance studies, previously described, from 35 percent to 50 percent of
the fluoride ingested in bone meal was not absorbed from the digestive tract and
ai)peared in the feces.
To conclude this inquiry into the most pertinent experiments that have been
performed on animal species, let us return to man and cite one series of observa-
tions upon the feeding of sodium fluoride in capsules to patients dying of incur-
able, malignant (cancerous) states. Black and his coworkers reported (39) upon
the results in 70 such individuals, adults and children. Children with leukemia,
a deadly disease of the blood forming organs, received a total daily dose of 80 to-
20O mg. : the average adult dose was 320 mg. daily. The usual period of medica-
tion was 3 or 4 months and even in periods up to 6 months no evidence of acute-
or chronic intoxication was detected. Microscopic examination of organs after-
350 FLUORIDATION OF WATER
death from the disease also failed to reveal damage to tissue. One patient is
reported to have received a total of 5G00 mg. intravenously in doses of 400 mg.
over a period of 9 days without apparent toxicity. Numerous investigators report
the personal ingestion of as much as 250 mg. at a single dose although an esti-
mated dose of 105 mg. has been reported to be fatal. These acute, short-term
experiments are not pertinent to the consideration of a water fluoridation pro-
gram with a daily dose of about 1 mg. of fluorine to the individual, young or old,
sick and well. They are introduced only to demonstrate that surprisingly large
Quantities of this chemical element, fluorine, have been taken daily under care-
ful scrutiny, often over considerable periods of time, by man and animals with-
out detectable ill effects.
We have, then, considered the evidence of all types gathered by systematic
study of individuals and of vital statistics and by laboratory investigation and
we have not encountered any hint of a health hazard in the ingestion of water
fluoridated naturally or by supplement to the physiologic level or even to a con-
centration four times as high. The reasons why no evidence of injury to health
has occurred or is to be anticipated have also been examined. They may best be
summarized by the statements : (1) The body shows no tendency to store fluorine
in physiologic dose, except for a very small fraction in the developing teeth. (2)
Excretion through the kidneys and skin of absorbed fluorine in ideal dosage is
practically complete. (3) On the basis of all evidence, these physicologic (func-
tional) processes are unchanged at levels of intake of fluorine at least four times
the ideal daily doses, thus providing a very wide margin of safety for the con-
sumer of properly fluoridated water, whatever his age or state of health. (4)
There is strong evidence to support the view that this factor of safety extends to
intakes of eight times the ideal daily dose and there is no published evidence to
the contrary.
Freedom to dissent from a popular view and the right to advance one's opinion
on any topic are among the most precious heritages of those who live under a
representative form of government. Fart of the price which we gladly pay for
the exercise of these rights is, inevitably, delay in instituting programs which
are either highly desirable or vitally necessary. Because of the need for accurate
definition of the problem to be faced and the merit of a specific proposal for
attacking it, confusion and controversy mark a predictable stage through which
the most meritorious proposal must pass. These result from impatience or inade-
quate explanation by its proponents and from honest doubt, unreasoning anxiety,
lack of understanding, suspicion of motives, sheer ineptness, or self-seeking ii^
various degrees on the part of opponents. These evidences of human imperfec-
tion form a pattern familiar to one who has studied the progress of legislative
proposals to supplement too low a natural concentration of fluorine in a com-
munity water supply. Every elected official of a municipality in which fluorida-
tion is contemplated is dutybound to consider the views of the objectors as well
as those of the advocates. It is important that he be fully informed as to the
nature and merit of the opposition. Those of us with scientific aptitude and
training who, as members of the medical profession, enjoy the public trust are
under the dual obligations of studying the issues which have been made to
appear controversial and to proclaim which arguments and attitudes have scien-
tific merit, classifying as irrelevent those which lack such quality.
In the enormous literature on fluorides and on fluoridation of water, scientific
publications or public testimony in opposition have appeared from six individuals
in particular whose scientific training and experience qualify them as deserving
of respectful attention and inquiry into the reasons for their views. They all
appeared before the Delaney committee in opposition to fluoridation of water.
Since their opposition is repeatedly cited by those who have little claim to
aptitude or opportunity for objective evaluation of the problem, detailed com-
ment is in order.
(1) Dr. Robert S. Harris, professor of biochemistry of nutrition, Massachusetts
Institute of Technology, brought his views into public attention in 1951 in a
letter (40) to a newspaper and made statements therein about the behavior
of fluoride in the body which, when he defines the concentration, are at variance
with the overwhelming weight of evidence or which leave the concentrations
undefined and therefore simply useless as a basis for discussion. The 12 points
into which his letter is arranged constitute an odd mixture of statements of
■widely supported fact, of allegations which cannot be documented, of others
■which have been disproven and of judgments with which the informed reader
may differ. Certain of his arguments were later elaborated in the form of 19
•auestions in testimony before the Delaney committee (of which, more later).
FLUORIDATION OF WATER 351
They have been thoughtfully answered (41) by Gerald J. Cox, Ph. D., director of
dental research, School of Dentistry, University of Pittsburgh, a distinguished
contributor to our factual knowledge of the effects of fluorine in human metab-
olism. Dr. Harris' questions reveal principally his wholly understandable wish
that more were known of the ultimate cause (if there be only one) of dental
caries. They raise no points, however, whose answers can be construed as being
unfavorable to a fluoridation program. This consideration has, obviously, im-
pressed itself upon Dr. Harris who has subsequently (1953) written a letter (42)
stating that he neither supports nor opposes fluoridation. This marks a decided
shift from his position taken in 1951 and expressed in 1952 before the Delaney
committee.
(2) V. O. Hurme, D. D. S., is research director, Forsyth Dental Infirmary,
Boston, Mass., in which institution dental service is provided for children. He
is the author of a paper (43) entitled "An Examination of the Scientific Basis
for Fluoridating Populations" and of a number of public statements questioning
the advisability of fluoridation of water supplies. His article produces no evi-
dence that fluoridation is either dangerous or ineffective. A study of his paper
leaves the reader with the convictions (a) that the author has failed to review
the voluminous literature which gives concrete evidence upon points about which
ne confesses himself to be in doubt and (b) that his use of such terms as mass
medication and compulsory procedures reveal an emotional bias which casts
doubt on his objectivity. A lengthy comment on points which Dr. Hurme has
characterized as controversial has been made subsequently in the same publica-
tion liy David B. Ast. D. D. S., director of the bureau of dental health, New York
State Department of Health, who has been, unlike Dr. Hurme, long noted for
his contributions to the scientific literature on this subject. Those who find
luemselves alarmed by Dr. Hurme's wish to delay fluoridation pending the
establishment of criteria which he does not, himself, define should read Dr. Ast a
rebuttal. To quote the latter verbatim, "Many of the accepted public health
procedures were generally applied with far less study and knowledge of the
mechanism by which they worked or side reactions than is known about water
fluoridation. I know of no public health procedure, including water chlorination,
Pasteurization of milk, or vaccination which has had the intensive and compre-
hensive study before it was applied as wafer fluoridation has had."
(3) The antifluoridation pamphleteers have made a major issue of a prema-
ture announcement of research by Alfred A. Taylor, Ph. D., at the biochemical
institute, the University of Texas (Austin). Dr. Taylor set out to study the time
of appearance of malignant breast tumors in a strain of mice used by many
laboratory workers because they are bred to the specific trait of developing such
tumors spontaneously in nearly 100 percent of animals. Dr. Taylor proposed to
give different concentrations of sodium fluoride in the drinking water of different
groups of the mice and to observe whether or not the age at which tumors
appeared would show any correlation with their respective intakes of fluorine.
As is their hereditary trait, practically all of the mice died with well developed
tumors of the breast. Dr. Taylor, unfortunately, sent a letter to Mrs. Marion E.
Lyon (of whom more anon) before he had carefully reviewed all the pertinent
data in his experiment and even before publication of his findings in a scientific
journal. She, as did other pamphleteers, quoted him at length and reproduced
his tabulated data to show that mice thought to be receiving 1 p. p. m. and 10
p. p. m. of fluoride in drinking water developed the breast tumors at an earlier
age than those receiving distilled water. This created a furor, as may be imag-
ined, and was used effectively to cause such alarm in lay minds that plans for
fluoridation in several communities were delayed for the time being. A furor on
a different plane, however, resulted when a research team from the U. S. Public
Health Service reviewed Dr. Taylor's plan of procedure and found (44) that the
solid food of the experimental animals consisted of a chow which, itself, con-
tained 42 p. p. m. of fluorine. As aftermaths. Dr. Edward Taylor, director of
dental health of the Texas State Department of Health wrote an article (44)
entitled "Facts Relative to Rumors that Fluoridation Causes Cancer," which was
published promptly in the Texas Dental Journal in refutation of the rumors.
Moreover, Dr. Chauncey Leake, vice president of the University of Texas and
one of the most respected men in the fleld of the medical sciences, wrote a let-
ter (45) to Dr. Edward Taylor expressing his regret over the incident and making
it plain that "there is no contraindication of fluoridation of drinking waters."
These, then, are the facts about the research and its attendant publicity which
have given rise to the allegations that water fluoridation programs increase the
352 FLUORIDATION OF WATER
risk of the development of cancer or that the effects of drinking fluoridated
waters may be particularly hazardous for persons who have cancer.
(4) Dr. A. L. Miller is a former State health ofiicer of Nebraska, from which
State he is now a Representative and a member of the Delaney committee ; as
such he made a separate statement and lias made other addresses on fluoridation
before Congress, taking a position in opposition to programs for the fluoridation
of community water supplies. His arguments disregard the weight of evidence
and do not show regard for the realities of the situation in his recommendation
that fluorine be provided by means of tablets or supplement in milk, as will be
shown later. He has tortured the meaning of words in attempting to "interpret"
tlie forthright approval Isy the American Medical Association of the fluoridation
of water supplies. He has fallen into serious factual error in using inappropriate
A'ital statistics in evaluating the incidence of circulatory diseases as a cause of
death in Grand Rapids, on which point he has been most clearly and courteously
set straight (46) by W. B. Prothro, M. D., public health director of Grand Rapids.
He has i)resented no acceptable evidence that fluoridation is either dangerous,
ineffective, or undesirable and his testimony has been challenged in detail else-
where (47t. His slatcinents h;ive. inevita'oly, been widely reproduced as a scien-
tific opinion in opposition to fluoridation. If he claims to speak with scientific,
rather than political authority, however, his attitude leaves much to be desired.
(5) Margaret C. Smith, Ph. D. and (6) her husband, Howard V. Smith, are
distinguished chemists who have for many years been associated with the Uni-
versity of Arizona, the former in human nutrition and the latter in agricultural
Tesearch, I'espectively. They were among the first to show by animal experiment
that mottled teeth could be produced by an excess of fluorine in the drinking
"water ; among their many valuable contributions are observations on the in-
'Creased incidence of flviorosis at higher environmental temperatures with a given
intake of fluoride. In their testimony before the Delaney Committee (loc. cit.,
pp. 1602-1614, 1614-1623) they stress the value of fluorine in reducing the inci-
dence of dental caries and state their acceptance of the work of the United States
Public Health Service in epidemiological studies of naturally fluoridated water
and in experimental studies of water supplemented by fluoridation (such as in
Grand Rapids. The expressed opposition to the extension of fluoridation pro-
grams to other cities (as of 1952) principally in their shared belief that sufiiciently
exact climatic data were not then available to set a concentration for a given
community which would be high enough to give maximum caries prevention, yet
low enough to prevent obvious dental fluorosis. A careful reading of their testi-
mony makes it clear that they consider even "questionable" or "very mild"
degrees of dental fluorosis, as defined by the United States Public Health Service,
to be not only toxic manifestations of fluorine intake but as esthetically objection-
able. Now, the definition of "very mild" dental fluorosis postulates only a few
very small, whitish, nonopaque areas on the back teeth, but not involving as much
as 25 percent of any tooth surface. Such are not detectable on examination by
the average physician or dentist, much less by the individual who has them. It
is therefore, the accepted opinion that they are not objectionable and that their
presence in as many as 10 to 15 percent of persons is not too high a price to pay
for the partial protection against caries obtained by fluoridation. It is doubtful
that the Smiths are on sound ground in differing with the dentists on this point
and insisting on classifying such findings as dental fluorosis, as defiguring and
as evidence of fluorine toxicity. Evidence has been published both before (9, 10)
and since (61) their testimony to substantiate their view that the generalization
is unsoup.d th;it 1 p. p. m. of fluoride is the ideal concentration for every com-
munity in the United States, regardless of climate, as will be elaborated. There
can be no quarrel on this point between the Smiths and many advocates of
fluoridation programs.
Such is the extent of the published dissent from the almost unanimous view
of those qualified through training and experience to exjiress themselves on the
scientific aspects of the situation. That the recorded anxietv as to possible,
usually unspecified ill effects on the part of so small a minority has been rejected
as contrary to tlie evidence or irrelevant is obvious in the approval of fluoridation
by the respected, responsible medical and dental organizations yet to be listed.
There is an equally impressive roster of advocates among men of science engaged
in teaching, in research, in public health activities and in water engineering. The
testimony of the opponents quoted above would be a slender reed to flourish in
aggressive opposition. It would be fatuous to assume that such constitutes the
backbone of determined efforts to prevent the wider adopion of fluoridation. It
FLUORIDATION OF WATER 353
is a simple matter to identify the sources of strengtli behind the avowed and
open resistance to fluoridation but assay of their various motives is sometimes
difficult. Several groups of pamphleteers regularly spread their antifluoridation
documents in communities which are entertaining proposals for fluoridation.
Pertinent data as to membership, methods of arrivinj; at policy, organization and
sources of funds are not often revealed. Close study of their printed material
gives a clear view, however, of their standards of reporting and what, for want
of a better term, may be termed their sense of responsibility. Space does not
permit the inclusion of the detailed critique which has been prepared. A few
allusions, quotations, and comments should be sufficient to characterize them.
Printed and mimeographed material from the following three sources have been
liberally circulated in metropolitan St. Louis and have been eifectlve, hitherto,
in their purpose.
(1) A compilation of mimeographed material was received on November
10, 19.")1, from the water commissioner of St. Louis, I\lr. Thomas J. Sklnker, at
the St. Louis Medical Society. It bears the name and address of Mrs. Marion
E. Lyon, 415 South Main Street, Geneva, N. Y., and the notation that it was ob-
tained from her on October 25, 1951. It consists of 14 sheets of paper with 46
numbered items of excerpts from newspaper stories, scientific publications,
speeches and letters addressed, presumably, to Mrs. Lyon. The authors are so
various in occupation as to defy classification and their attributed claims to au-
thority are, at times, obscure. Reference will be made to the paragraphs as num-
bered, for the convenience of those in possession of copies of this document.
The comments to be made are concerned with views attributed to those individ-
uals whose stated professional position immediately rriuses the interest of the
reader. As might be expected, the opinions of Alfred Taylor, Ph.D., the unhappy
outccmie of whose observations on breast cancer in mice will be recalled, are set
forth in paragraphs 1, 16, and 37, paragraph 16 being devoted to his letter, itself
to Mrs. Lyon. The views of Dr. V. O. Hurme (43) appear in paragraphs 24 and
35 and Dr. Robert S. Harris' letter (40) of February 25, 1951, is quoted in part in
paragraph 33. The portion of Dr. Harris' letter testifying to the effectiveness of
fluoridation is not reproduced.
To the uninitiated, the appearance of testimony by Dr. LIuntington Williams,
M.D., health commissioner of Baltimore, in paragraph 11, by Winston H. Tucker,
M.D., health commissioner of Evanston, Illinois, in paragraph 26 and by Dr.
J. L. T. Aj)y)leton, professor of Microbiology in the school of dentistry, University
of Pennsylvania, in paragraph 34, that fluoridation should be undertaken only
as an experiment comes as a shock luitil one notes that these statements are
undated. Inquiry shows that Dr. Williams subsequently recommended (48)
on March 3, 19.52, fluoridation of the water supply of Baltimore and this was
put into effect on November 26, 19.52. Dr. Tucker's statement was made in Oc-
tober of 1951 ; his advocacy of fluoridation for other communities has been made
clear (16). Dr. Appleton's quoted statement was made in May, 19.50: he is a
declared advocate of fluoridation and, as a member of the ad hoc committee on
fluoridation of water supplies. National Research Council, participated in the
preparation of that report (7) which recommended fluoridation in November,
1951. These gentlemen are distinguished students of the effects of fluoridation,
of conservative and mature judgment and in positions of grave responsibility.
They had no hesitancy about counseling a cautious approach in earlier years.
Statements in opposition to fluoridation are attributed in paragraph 26 to Dr.
E. V. McCollum, professor emeritus of biochemistry of .Johns Hopkins University,
one of the great scientists of his generation, whose textbook is known to every
medical student of the past .50 years. Mrs. Lyon has released material quoting
one Harold Lamb. D.M.D.. who quotes an alleged letter dated August 21, 1950,
attributed to Dr. IMcCollum, in these words. "This measure of prevention, in
some measure, the high incidence of dental caries, is in the experimental stage.
So far as I am aware, it has not been found to be effective where it has bee^n
tried." Dr. Lamb thereupon assures the reader that this statement "may be
verified at sources by any who wish to take the trouble to write." Upon in-
quiry, Dr. McColhnn has denied (49) being the author of such a letter and has
challenged the Citizens' Medical Reference Bureau to verify its existence, which
they have not, apparently, undertaken to do. An issue far more grave than
mere obsolescence of viewpoint has been introduced by the inclusion of material
whose authenticity has been repudiated. No explanation from Mrs. Lyon, Dr.
Lamb or the Citizens' Medical Reference Bureau has come to our attention.
In portions of the Lyon document which purport to abstract original source
material from the scientific journals, no pretence of reporting objectively the
354 FLUORIDATION OF WATER
whole purpose and conclusion of each author is evident to one who has studied
the original publications. In paragraph 22 appears an excerpt attributed to the
April 1951 issue of Prevention, a magazine devoted to the conservation of
human health (of which, more later). This excerpt is written in such a way
as to give the reader the impression that all the material in it expresses the find-
ings and viewpoints of the studies (2, 3, 37, 3S) on fluoride balance and the
differences in solubility and absorbability between bonemeal and sodium fluoride,
reviewed earlier in considerable detail. Whoever prepared the material for pub-
lication in Prevention, however, has very carefully selected certain data of the
authors and written it up in such a way to include his own comments as though
they were the remarks of the authors. He has omitted all data, references and
conclusions unfavorable to his cause, Jackson (38) aoid Largent (3, 34) would
be amazed to learn that an uninformed person, reading paragraph 22, would
probably draw the conclusions that they considered bonemeal to be a safer or
more appropriate method of administering fluorLne than by the fluoridation of
the water supply for liuman beings. And McClure (2, 16) one of the most
prolific contributors of studies on the metabolism of fluorine, would never dis-
cover, in reading the mixture of his data taken out of context and special plead-
ing by the reviewer, that he, himself, was a consistent advocate of fluoridation.
The evidence advanced above should be sufficient to thoroughly discredit the
printed matter emanating through the Lyon document, from the Citizen's Refer-
ence Committee and in Prevention. A further comment on the last is in order.
Perusal of several reprints have shown a continuing devotion to the exploded (46)
views of Representative Miller and Dr. Alfred Taylor more than a year after
Dr. Leake's repudiation of that affair (45). In response to request, the assistant
editor of Prevention sent a copy of the issue of June, 1953, with a cordial letter
stating : "As you will see, we do not advocate the health policies of any special
group. We do research in medical and scientific magazines and publish the results
of our findings as they relate to prevention of disease. It is our opinion that
a correct diet and way of life will in general prevent many of the diseases of
twentieth century life." A study of the issue submitted reveals that such a
disclaimer is less than candid. The character of the advertising and of the
news articles leads only to the conclusion that this magazine follows tlie line
of thought known as Naturopathy. It includes an antifluoridation article by the
same lay author whose diatribe against fluoridation was published in February,
1953, issue of Harpers Magazine and consists of the usual mixture of allegations
which form such a familiar pattern. While they concentrate on the "Opera-
tion Rat Poison" theme to characterize the fluoridation movement, the.v seem
most concerned (50) about the use of the community water supply as a vehicle
for fluorides and they occasionally suggest that fluoride intake for i-eduction
of dental caries may be desirable if it is ingested in some other vehicle. One
wonders whether this press has sent pamphlets into those communities which
have installed defiuoridation plants in order to reduce the high concentration
elsewhere as they oppose supplementing the low concentration in St. Louis and
St. Louis County. If not, their devotion to natural w^ater is tainted, if the former
adjective can be fairly applied to any aqueous solution treated as is our own
to make it acceptable from the estlietic viewpoint as well as from considerations
of self-preservation. Clearly, the human ingestion of adequate amounts of fluo-
ride as bonemeal or pablum is acceptable to this publication, as stated in the
excerpt attributed to it in paragraph 22 of the Lyon document. Without any
imputation as to the motivation of this publication, its position is quite Incon-
sistent, it has no discernible scientific status and its standard of reporting makes
any of its statements on this subject imacceptable as evidence.
The product of a third pamphleteer, W. D. Herrstom, of Faribault, Minn.,
is worthy of note. It is entitled "Americanism Bulletin," selling for 10 cents
per issue. The September, 1951, issue (51) was sent into St. Louis as recently
as July, 1953. It contains "25 reasons why community water supplies should
not be fluoridated." These contain no evidence of either scientific or educa-
tional value, but express concern lest a saboteur fatally poison an entire com-
mimity through excessive fluoridation by the mere twist of a valve. Fluorida-
tion is described also as a subtle enemy plot to weaken the mental powers of
the American people in order that they will fall an easy prey to "Satanic
dictatorship." Another issue appeals strongly to fear of foreign domination
and describes the entire fluoridation movement as a plot by socialistic stooges
of Mr. Oscar Ewing. The implication is plain that any supporter of fluorida-
tion is necessarily an admirer of Mr. Ewing's politico-economic views. This
FLUORIDATION OF WATER 355
is entertaining grounds for polemics but is far afield from a discussion of the
merits of fluoridation or of possi-ble hazards to health.
The opponents of fluoridation whose efforts are chiefly confined to pam-
phleteering at 10 cents a copy tend to quote one another oud operate in effect,
as a team. All have laid much stress on the failure of the Delaney committee
to approve the principle of fluoridation of community water supplies. It is
fair to state that many opeumiuded, genuinely inquiring persons without the
ability to evaluate scientific evidence have been much impressed by the Delaney
report (52) and such is the natural reaction to what purported to be a con-
gressional hearing of scientific testimony. The report itself is, we believe,
very fair in intention. It reflects a clearly-expressed sense of responsibility
on the part of the members of the committee not to reach a hasty conclusion
nor one which might conceivably result in harm to the population of any com-
munity in the United States.
The report itself, however, is much fairer in tone than was the atmosphere
of the hearings, as a close reading of the latter makes obvious. A contentious
attitude, particularly toward witnesses from the United States Public Health
Service, seems to have been displayed by the chief counsel and by one of the
members of the committee and moved Representatives Paul C. Jones, of Mis-
souri, and Walt Iloran, of Washington, themselves members, to protest against
a prosecuting attitude toward certain advocates of fluoridation.
We shall not go into a detailed commentary here, as that has been done
previously (53) with, we believe, full effectiveness. We would characterize
the report, not as bad, but as disappointing in that it (1) failed to give due
emphasis to the better evidence in the hearings and (2) sought for perfect and
complete knowledge in a scientific field unlike that demanded of any other in
which reliable data for day-to-day application are available. To deny the
validity of the evidence for the safety of fluoridation today pending the com-
pletion and extension of experimental investigations is to disregard what has
already been learned and to introduce the concept of a conflict between prac-
tice and investigation which is not valid. The additional views, filed as a
separate report by Representative Miller have been commented on previously.
Ho is in factual error in the notion that only persons under S years of age
will be benefited by fluoridation and he is guilty more than once of interpret-
ing statements of the American Medical Association to derive meanings which
are contrary to the accepted usage of the English language. In response to
a recent inquiry, George F. Lull, M. D., secretary of the American Medical
Ascociation, has furnished (54) a complete copy of his statement to the
Delaney committee (55). The council on pharmacy and chemistry and the
council on foods and nutrition unequivocally state : "After considering the
evidence available at this time, the councils believe that the use of drinking
water containing xip to 1 part per million is safe." The reasons given for
avoiding additional intake of substances of high fluorine content and the wis-
dom of varying the seasonal concentration of fluoride ion in the water, accord-
ing to the climatic conditions, will be familiar to the reader. The councils
quite properly limited their statement to consideration of the health hazard.
That they refrained from urging communities to support or oppose fluoridation
is simply recognition of the fact that the evaluation of the need for fluoridation
in a given community and the assurance of the benefit to be expected from
such a local program can best be made by members of the dental profession.
Any group of physicians 'would be presumptuous in setting themselves up as
hetter judges of the latter points than the dentists of the community and of
the various health services. The house of delegates has followed a similar
viewpoint but endorsed the principle of fluoridation as a forceful statement
of their belief in its safety and effectiveness.
Many opponents of the fluoridation of water supplies have recognized the
merit of a daily intake of fluorine in approximately 1 mg. dosage to increase
the resistance of the teeth to caries, provided that another menus of ingestion
he provided. Such alternatives suffer from either the risk inherent in dispens-
ing necessarily concentrated stock solutions or the uncertainty of dosage
throush bread, milk, salt or other foodstuffs whose intake by the individual
varies much more widely than does the total intake of water (including the
water in solid food). The expense and the distribution problems involved in
the dispensing of tablets make them an impracticable choice also as a vehicle
of preventive medicine. An elaboration (5f)) of the relative tmsuitability of
all these methods has been furnished by Robert E. Shank, M. D., professor of
356 FLUORIDATION OF WATER
preventive medicine and public liealth, Washington University School of Medi-
cine, St. Louis, Mo. Topical application of relatively concentrated solutions
of fluorides (directly to the teeth) have proven to be of definite value as a
measure of individual prophylaxis against tooth decay. It is widely held to be
less effective than systemic intake of fluoridated water from birth. The limited
dental personnel available in both public health work and in private practice
and the expense of such a method make it a poor choice of methods of prophy-
laxis in comparison with fluoridation of a community water supply. It is
wholly impracticable as a public health measure, therefore, in any but the
small communities or in rural areas. One of the major, secondary benefits to
be derived eventually from a fluoridation program is the partial release of
dental personnel from the treatment of caries and its complications in order
that they may devote more time to oral (mouth) prophylaxis and other phases
of dentistry.
It is outside the scope of this report to present the evidence for the effective-
ness of fluoridation in those communities in which the concentration of fluorine
ion in the water supply was formerly less than ideal. This is the prerogative
of those members of the dental and public health professions who have made
a lengthy study of the accumulated data. Suffice it to say that we have reviewed
many published studies and have been furnished current, as yet unpublished
statistics from certain communities which give impressive testimony as to its
merit. The close correlation between endemic (natural) fluoride ion concen-
tration of a community water supply in inverse relationship to the incidence of
dental caries at a given age level is a marvel of statistical acceptability. The
clarification of this relationship by Dean (.^7) and others followed from earlier
demonstrations (58) that disfiguring brownish mottling of the enamel was due
invariably to a high fluorine content of water and that where mottling (dental
fluorosis) was common, caries was relatively uncommon. These fundamen-
tal observations are a brilliant chapter in American science. Naturally enough,
the first practical applications to which they were put were the development of
means for removal of excessive fluorine from the water. Such programs of
defluoridation were in operation for years before sufficient data had been gath-
ered to permit the safe beginning of programs to supplement waters naturally
deflcient in fluorine. It is of particular signiflcance that the people of the city
of Muskegon, ]Mich. (which had only a trace of fluorine in its water and was
teamed with Grand Rapids for continuing comparison upon the initiation of
fluoridation in the latter city in 194.5) have become so impressed with the reduc-
tion of dental caries in the children of Grand Rapids that they have ceased
to provide a baseline for comparison by initiating the fluoridation of the Mus-
kegon water (25). The greatest benefits are seen in those persons who have
received an adequate daily amount of fluorine from birth and this benefit has
been clearlv demonstrated to extend in such persons into adult life, as shown
by comparative dental studies (.59) of adults up to the age of 44 living in Colo-
rado Springs (2.5 p. r>. m.) and those living in P.oulder. Colo., which has practi-
cally no fluorine in its natural water supply. All of the residents raised in a
community with an adeqiiate concentration of fluorine will be benefited thereby
in time, not merely the school children. It is not widely enough appreciated,
however, that the benefit in reduction of caries from initiation of a fluoridation
program in a given community will be proportionate to the concentration of
fluoride ion at the outlets of the water system prior. to the start of the opera-
tion. The city with a natural concentration of 0.5 p. p. m., for example, can ex-
pect decidedlv less reduction of caries experience than one with only a trace of
fluorine for the people of the former will have the lower incidence of caries prior
to fluoridation.
The need for increasing the concentration of fluoride in the water supplies of
metropolitan St. Louis has been strongly stated, the entire issue of the bulletin
of the St. Louis Dental Sopietv, Anril 105^?. havinf^ bp<^n devoted to paTi^rs and
communications on the sub.iect of fluoridation. Collected data reported else-
where (60) show that the children of this community have an experience of
caries somewhat below the level anticipated from the average fluoride ion con-
centration of approximately 0.3 p. p. m. and more nearly that to be expected
from a water supply containing 0.5 p. p. m. This is not necessarily of importance ;
it may be interpreted as being due either to conservative evaluation of observed
caries or to the existence of climatic conditions (higher temperature and humid-
ity) in the Mississippi Valley of a more tropical nature than we generally assume.
Too many other nutritional and oral factors enter into caries incidence to permit
FLUORIDATION OF WATER 357
a specific explanation of this point. It must be talcen into account, however, in
considering to what concentration fluoride supplement sliould be addpd to the
municipal water supply and in attempting a prediction of what reduction of
caries incidence is to be anticipated thereby.
As has been stressed, the ideal concentration of fluorine to be approximated
for any community must be arrived at by consideration of its climatic character-
istics and a lower concentration supplied in seasons of consideralile warmth and
humidity; there is new evidence (Gl) that dental fluorosis occurs at lower con-
centrations of fluorine where such weather is prolonged than in more temperate
areas. With such a reservation as to actual concentration to be attained, we
strongly endoi-se the statement on March 1, 1951, by the health commissioner of
St. Louis, J. Earl Smith, M. D., stating the ofiicial position of the St. Louis health
division and recommending the fluoridation of the St. Louis water supply. Dr.
Smith has done well to point out that "Fluoridation does not eliminate tooth
decay entirely * * * fluoridation is not a cure-all ; good dental care will con-
tinue to be a necessity. Fluoridation is a preventive measure but is not IW per-
cent effective. It is no more a substitute for good dental care than pasteurization
is a substitute for the clean production of milk. It is, however, a long stride for-
ward in the fight on man's most common defect, tooth decay.
As citizens, as well as physicians, we should be mindful that no evidence of
harm to any industrial process fi'om the use of water containing as little as 1
p. p. m. of fluoride has been published. On the contrary, there is much testimony,
based \ipon investigation in their own laboratories, that the products of bakers
(62). canners (6::!), and brewers (64) will suffer no deleterious effect. The fears
recently expressed (6.t) by G. S. Bratton, technical adviser to the president,
Anheuser Busch, Inc. of St. Louis, fall into two categories, (1) that the making
of beer itself may suffer through effects on the yeast (contrary to the evidence
cited) and (2) that the increased concentration of fluoride through such proc-
esses as produce byproducts (which are used in other foods) will exceed per-
missible limits (approximately 5 p. p. m.), Bratton has been answered, step by
step, by W. Victor Weir, president, the St. Louis County Water Co., in an address
(66) which should be studied by anyone interested in this phase of the effects
of fluoridation. Reprints are obtainable from his office. None of the national
distributors of beer has openly opposed fluoridation of their community water
supplies but it so happens that none of them is located in a community which
has, as yet, initiated fluoridation of its water except Milwaukee which initiated
fluoridation July 1953. We have every confidence that members of the brewing
industry will not in the future offer either open or overt opposition to a program
of preventive medicine that is .so demonstrably in the public interest. The reader
mu.st realize that the breweries of Milwaukee used water from deep wells con-
taining an average of 0.9 p. p. m. (one as high as 1.8 p. p. m.) of fluoride ion from
the year 1879. In more recent years, many breweries established private filtra-
tion plants for the use of Lake IMichigan water, but now use the municipal water
supply which contains only a trace of fluorine. As for other points of interest,
fluorides at the specified concentration have no bactericidal (germ-killing) effect,
do not affect the compounds formed in water after chlorination and provide all or
part of the fluorine needed to remove silica from boiler water, depending upn
which compound is used. There have been no effects on sewage treatment proc-
esses, the fluoride concentration of sewage quickly reaching that of the water
supply (67).
As of August 1, 1953. the following major cities in the United States are fluori-
dating their water supplies: Baltimore, Md., Washington, D. C, Pittsburgh, Pa.,
Cincinnati, Ohio, San Francisco and San Diego, Calif., Tulsa. Okla., Louisville,
Ky.. Indianapolis, Ind., and Milwaukee, Wis. Philadelphia, Pa., has authorized
fluoridation. Together with the more than 700 other communities in 43 States,
a total population of more than 14 million, are using water supplemented with
fluorine. Missouri is 1 of the 5 States in which no fluoridation is being practiced,
the others being Arizona, Nevada, New Mexico, and Utah.
Exhibit 1
Stability of an Element
The fundamental premise upon which the science of chemistry is based is that
of the uniformitv of identity of any element. For instance, all sodium ions with
an atomic weight of 23 are identical in properties, no matter what their source.
The atomic weight determines the structure of the atom and informs the chemist
358 ' FLUORIDATION OF WATER
of the element's characteristic properties and reactions. Ephraim states, "The
atomic nucleus * * * (is) an extremely stable system." ^
Along with all other chemists, Profs. S. S. Cooper and C. N. Jordan of the
St. Louis University Department of Chemistry stated recently that fluoride ion
from one source is identical with fluoride ion from all other sources.^
E. A. DoiSY, Jr., M. D.
Editorial Note. — Due to lack of space, only exhibit 1 is reproduced. Exhibits 2 to 21 are
on file at the St. Louis Medical Society and are available for inspection.
The Committee was appointed by Dr. A. N. Arneson, M. D., President, on Jan-
uary 30, 1953.
Members of the Committee
Harold A. Bulger, M. D., Assistant Professor of Clinical Medicine, Washing-
ton University School of Medicine.
Raymond O. Muethei-, M. D., Associate Professor of Internal Medicine, St.
Louis University School of Medicine, and Director of Laboratories, St. Mary's
Group of Hospitals.
Willard Bartlett, M. D., Chairman, Assistant Professor of Clinical Surgery,
St. Louis University School of Medicine.
Consultants of the Comm,ittee
Edward A. Doisy, Jr., M. D., Assistant Professor of Internal Medicine, St.
Louis University School of Medicine.
Robert E. Shank, M. D., Professor of Preventive Medicine and Head of Pre-
ventive Medicine and Public Health ; Professor of Preventive Medicine in Depart-
ment of Medicine, Washington University School of Medicine.
J. Earl Smith, M. D., Senior Instructor in Internal Medicine, St. Louis Univer-
sity School of Medicine, and Health Commissioner, the City of St. Louis.
BiBLIOGRAPHT
(1) Statement by E. A. Doisy, Jr., M. D., received July 11, 1953. (Exhibit 1.)
(2) McClure, F. J., et al. : J. Indust. Hyg. & Toxicol. 27: 159-170 (June) 1945.
(3) Machle, W., and Largent, E. J.: J. Indust. Hyg. & Toxicol. 25:112
(March) 1943.
(4) Hevroth, F. F. : Am. J. Pub. Health 42 : 1568-1575 (December) 1952.
(5) U. S. Public Health Reports 61 : 371, 1946.
(6) Dean, H. T. : Dentistry in Public Health, p. 136, Philadelphia, W. B.
Saunders Co., 1946.
(7) Report of ad hoc Committee, National Research Council, p. 3, November
29 1951
'(8) Cox, G. J., and Hodge, H. C. : J. Am. Dent. A. 40: 440-451 (April) 19-50.
(9) Dean, H. T. : J. Am. Water Works A. 43 : 17-21, 1951.
(10) Arnold F. A.: J. Am. Dent. A. 30: 499-508. 194.3.
(11) Hearings before the House Select Committee, etc.. House Rep., 82d Con-
gress. 2d session, Pursuant to House Res. 74 and House Res. 447, Part 3, 1952,
p. 1655-p. 1769.
(12) Hill, I. N.: Jelinek, O. E., and Blayney, J. R. : J. Dent. Res. 28:398-414
(August) 1949.
(13) Schesinger, E. R. ; Overton, D. E., and Chase, H. C. : Am. J. Pub. Health
40 : 725 (June) 1950.
(14) N. Y. State Dept. of Health Bull. 5 : August 13, 1952.
(15) Personal communication from W. H. Tucker, M. D., dated March 9, 1953.
(Exhibit 2.)
(16) McClure, F. J. : U. S. Pub. Health Reports 59 : 1511, 1944.
(17) Grodowitz, W. : Cancer Morbidity, Series 2, 1951. Federal Security
Agency, U. S. Public Health Service.
(18) Mercus, S. C. : Cancer Morbidity, Series 4, 1951. Federal Security Agency,
U. S. Public Health Service.
1 Ephraim, F., Inorganic Chemistry. Nordeman Publishing Co., Inc., New York, ed. 4,
1943, p. 9.
* Personal communication.
FLUORIDATION OF WATER 359
(10) Forsvth. B. D. : House Rep., S2d Consross, 2cl session, loc. cit. p. 1C36.
(20) Sommers, H. J. : U. S. Public Health Reports 57 : 1566, 1942.
(21) Sommers, H. J. : Ibid. p. 1971.
(22) Wisconsin State Board of Health, continuous resident data, 19ol.
(23) Personal communication from G. J. Hildebrand, M. D., dated February
26,1953. (Exhibits.)
(24) Personal communication from AV. B. Prothro, M. D., dated February 27,
1953. (Exhibit 4.) ,^ ^^ __.,
(25) Personal communication from C. V. Tossy, D. D. S., dated May 14, 19o3.
(Exhibit 5.) ,, , ,- ..nt-o
(26) Personal communication from Fred D. Welch, M. D., dated March 5, 1953,
(Exhibit 6.) ^. ^^
(27) Form letter to presidents of 15 local medical societies. (Exhibit 7.)
(28) Form letter to 15 District Health Officers. (Exhibits.)
(29) Personal communications from presidents of local medical societies and
from District Health Officers in eight other cities. (Exhibit 9.)
(30) Fluoridation of Water Supplies, Iowa State Dept. of Health, 1951.
(31) Hodges, P. C, et al. : J. A. M. A. 117 : 1938, 1941.
(32) Brun, G. C. ; Buchwalk, H., and Roholm, K. : Acta. Med. Scandinav.
106 : 261, 1941.
(33) Largent, E. J.; Bovard, P. G., and Heyroth, F. F. : Am. J. Roentgenol.
65:42 (January) 1951.
(34) Largent, E. J. : Arch. Ind. Hyg. & Occup. Med. 6: 37 (January) 1952.
(35) Roholm, K.: quoted by Heyroth, F. F. : Am. J. Pub. Health 42:1568
(December) 1952.
(36) Largent, E. J.: quoted by Heyroth, F. F. : Am. J. Pub. Health 42:1568
(December) 1952.
(37) Greenwood, D. A., et al. : J. Dent. Res. 25 : 311 (October) 1946.
(38) Jackson, S. H., et al. : J. Nutrition 40 : 515-535 (April) 1950.
(39) Black, M. M. ; Kleiner, I. S., and Bolker, H. : New York J. Med. 49 : 1187
(May 15) 1949.
(40) Tearsheet from a pamphlet entitled "Fluoridation," by H. B. Anderson,
Secretary Citizens' Medical Reference Bureau, price 100. (Exhibit 10.)
(41) Copy of address by Gerald J. Cox, Ph. D., delivered June 20, 1952.
(Exhibit 11.)
(42) Letter from Robert S. Harris, dated Jan. 20, 1953. (Exhibit 12.)
(43) Hurme, V. C, Dental Items of Interest, 74 : 518-534, June, 1952.
(44) Taylor, Edward, Texas Dent. J., 69 : 381, September, 1951. (Exhibit 13.)
(45) Copy of a letter from Chauncey Leake, dated October 1, 1951. (Exhibit
14.)
(46) Copy of a letter from W. B. Prothro, M. D., dated June 2, 1952. (Exhibit
15.)
(47) Doty, J. R., and Phair, W. P.: J. Am. Dent. A. 45: 351-356 (September)
1952.
(48) Williams, H. : Baltimore Health News 29: 42 (August) 1952.
(49) Letter from E. V. McCollum, dated January 6, 1953. (Exhibit 16) Pub-
lished in The Bulletin, St. Louis Dental Society, 24: 22 (February) 1953.
(50) Reprint from Prevention, A Magazine Devoted to the Conservation of
Human Health. (July) 1952. (Exhibit 17.)
(51) Excerpts from Americanism Bulletin, No. 17, (Sept.) 1951. (Exhibit 18.)
(52) Report of the Select Committee, etc.. House of Rep. 82nd Congress, 2nd
session, pursuant to H. Res. 74, S2nd Congress, 1st session, (July 10) 1952.
(53) Doty, J. R., and Phair, W. P. : J. Am. Dent. A. 45 : 351-356 (September)
1952.
(54) Personal Communication from George F. Lull, M. D. (Exhibit 19.)
(55) Statement submitted on February 27, 1952 to House Select Committee on
behalf of American Medical Assn. by George F. Lull. (Exhibit 20.)
(56) Statement by R. E. Shank, M. D., dated June 27, 1953. (Exhibit 21.)
(57) Dean, H. T., et al. : J. Am. Water Works A. 35 : 1161, 1943.
(58) McKav, F. S. : J. Am. Dent. A. 15 : 1429 (August) 1928.
(59) Russell, A. L., and Elvove, E. : Pub. Health Reports 66:1389-1401, 1951.
(60) Report of the Mayor's Committee on Water Fluoridation, St. Louis, Mis-
souri, 1953, E. E. Nelson, M. D., Chairman.
(61) Galagan, D. J., and Lamson, G. G., Pub. Health Reports 68:497-507
(May) 1953.
360 FLUORIDATION OF WATER
(62) Faulstich, C. B. : Am. Institute Baking Bull. No. 66 (July 6) 1950.
(63) Greenleaf, C. A. : National Canners A. Res. Rep. No. 6-51 (June) 1951.
(64) Slater, R. R. : Proc. Am. Soc. Brewing Chemists, p. 60, 1951.
(65) Bratton, G. S. : J. Am. Water Works A. 45 : 334-368 (April) 1953.
(66) Weir, W. V. : J. Am. Water Works A. 45: 369-375 (April) 1953.
(67) Maier, F. J. : J. Am. Water Works A. 42 : 1120-1132 (December) 1950.
Mr. Hale, The committee will now stand in recess until 2 p. m.
(Thereupon, at 12:28 p. m., the committee took a recess until 2
p. m,, of the same clay.)
AFTERNOON SESSION
The hearing was resumed at 2 p. m.
Mr. Hale. The committee will come to order.
Congressman Derounian has asked leave to submit the follow-
ing telegram from Dr. Joseph G. Zimri)ig, chairman of the legisla-
tion committee of the Nassau County ISIedical Society, and letters
from Dr. S. S. Medvin, secretary of the Suffolk County Dental
Society, Dr. Charles A. Wilkie, secretary of the Dental Society of the
State of New York, and Dr. Solomon N. Rosenstein, j)resident, the
New York State Society of Dentistry for Children, for the record.
If there is no objection, it is so ordered.
(The documents referred to are as follows :)
MiNEOLA, N. Y., May 20, 1954.
Hon. Steven B. Derounian,
House Office Building, Washington, D. C:
The Nassau County Medical Society wishes to go on record as supporting the
dental profession's opposition to the proposed autifluoridation bill H. R. 2341
which seeks to prohibit fluoridation of certain water supplies.
Joseph G. Zimring, M. D.,
Chairman, Legislation Committee.
Suffolk County Dental Society,
Patchogue, N. Y., May 21, 195^.
Representative Steven B. Derounian,
House of Representatives, Washington, D. C.
Dear Sir: On May 19, 1954, our society in a general meeting unanimously
voted to request your cooperation as a representative of the State of New York
in preventing the enactment of the Wier bill, H. R. 2341 ; a bill to protect the
public health from the dangers of fluoridation of water.
Fluoridation of community-water supplies, is an established fact for over
20 million people. Its success as a retardaut of dental caries (cavities) has
been proven in many studies. In our own State of New York, the Newburgh-
Kingston experiment conducted by the State health department has conclusively
proved the benefits of water fluoridation. There has been no evidence of any
harmful effects from proper fluoridation from this and other scientifically con-
trolled investigations.
Unfortunately opposition to fluoridation seems to be an emotional or prejudicial
factor and is not based on any scientifically proven theory. Even the Christian
Science organizations no longer oppose fluoridation.
Please prevent the passage of H. R. 2341 and thus enable our future population
to be one of greater dental health.
Sincerely yours,
S. A. Medvin, D. D. S.,
Secretary, Suffolk County Dental Society.
FLUORIDATION OF WATER 361
The Dental Society of the State of New York,
May IS, lOo.'f.
Hon. S. Derounian,
The House of Representatives,
Washington, D. C.
Dear Sir : At the annual meeting of the Dental Society of the State of New
York, the following action was taken by the governing body :
"The Dental Society of the State of Is'ew York on many occasions has stated its
approval of the fluoridation of community water supplies.
"Epidemiological studies have demonstrated that no harmful effects have re-
sulted from this procedure when it is applied under properly controlled condi-
tions. Further controlled studies have indicated beyond doubt that the pro-
cedure does in fact materially reduce dental decay in the teeth of children.
"Fluoridation of community-water supplies is enthusiastically endorsed as a
public-health measure by such organizations as the American Dental Associ-
ation, the American Medical Association, the American Public Health Associ-
ation, the United States Public Health Service, the National Research Council
and other national and local organizations of scientific repute.
"Therefore, the Dental Society of the State of New York takes this oppor-
tunity to reiterate its approval of the fluoridation of community water supplies
where practicable as a means of reducing the incidence of dental disease."
For the above-mentioned reason, may I earnestly request that you support the
action of the dental profession in opposing the Wier (antifluoridation) bill,
H. R. 2341.
Very truly yours,
Charles A. Wilkie, D. D. S.,
Secretary,
The New York State Society of Dentistry for Children,
May 18, 1954.
Congressman Steven B. Derounian,
Memher, Interstate and Foreign Commerce Committee,
House of Representatives, Washington, D. C.
Dear Mr. Derounian : During the annual meeting of our New York State So-
ciety of Dentistry for Children, we were informed of the Weir bill, the enactment
of which prohibits fluoridation of public water supply by communities.
In the light of scientific findings published to date, I feel that enactment of
such legislation would be unwise and not in the interest of maintaining good
dental health for the children in all communities.
The scientific evidence so far presented indicates that an appreciable degree
of reduction of new dental caries results from the addition of 1 to 2 parts fluoride
per million parts of water. Also at such dilution, findings indicate that there is
absence of unfavorable accompanyLng signs or conditions.
It would be in the best interests of good dental health for children, and thereby
contribute to their general good health to prevent passage of such prohibiting
legislation.
Sincerely yours,
Solomon N. Rosenstein, DDS,
President.
Mr. Hale. We will resume the hearing on H. R. 2341, and the wit-
nesses who will testify will be Dr. John Knutson, chief dental officer,
Public Health Service, Dr. N. C. Leone, chief, medical investiojations,
National Institute of Dental Research, and Dr. Isadore Zipkin of the
National Institute of Dental Research.
The committee is pleased to have you gentlemen with us.
Will you please proceed in your own way ?
362 FLUORIDATION OF WATER
STATEMENTS OF DR. JOHN W. KNUTSON, CHIEF DENTAL OFFICER,
PUBLIC HEALTH SERVICE; DR. NICHOLAS C. LEONE, CHIEF,
MEDICAL INVESTIGATIONS, NATIONAL INSTITUTE OF DENTAL
RESEARCH; AND DR. ISADORE ZIPKIN, SENIOR SCIENTIST,
NATIONAL INSTITUTE OF DENTAL RESEARCH
Dr. IvNUTSON. Mr. Chairman and members of the committee, I am
glad to meet with the members of this committee to present the view
of the Department of Health, Education, and Welfare on H. R. 2341,
a bill to prohibit fluoridation of public water supplies. Our position
on this bill has been presented in Secretary Hobby's letter of January
20, 1954, to the chairman of this committee. In her letter the Secretary
noted that the bill would categorically prohibit Federal, State, or local
governmental agencies from treating public water supplies with any
fluoride compound and from making water so treated available for use
by or on behalf of any such agency. She stated that it is the view of
the Department of Health, Education, and Welfare that the decision
on whether to fluoridate public water supplies should continue to rest
with the local communities. We believe that they are entirely com-
petent to make such decisions and that Federal intervention, either to
require or to prohibit fluoridation, would not be justifiable.
The Secretary also referred, in her report on the bill, to the ex-
tensive research which has been done by the Public Health Service
and many other investigators on fluoridation. I would like to review
the highlights of this research with particular emphasis on the effec-
tiveness and safety of this procedure. Later, I should like to discuss
the relationship of water fluoridation to the total dental problem
in the United States, as well as the role of the Public Health Service
with respect to this preventive measure.
Our position favoring the adoption of fluoridation is based on
several decades of study of the uses, action, and effects of fluoride
compounds on both animals and humans. Because of the widespread
distribution of fluorides in nature, especially in water, scientists had
a natural laboratory of unprecedented scope in which to study this
element. The opportunity for detailed study of the biological effects
of fluoride consumption has led to the development of an unusually
large body of knowledge on this subject. Today the list of scientific
writings on fluoridation, including books, papers, and reports, runs
to more than 7,000 publications.
Substantial evidence that dental caries is influenced by small
amounts of fluoride was accumulated during the 30-year period
1908-38. The research efforts of this era led to the hypothesis that
the use of drinking water with one part of fluoride per million parts
of water will reduce the amount of tooth decay in humans by two-
thirds.
From 1938 through 1945, intensive studies were conducted to follow
up this promising lead. These investigations, in the field and in the
laboratory, on animals and on man, further demonstrated the dental
benefits that had been reported, and at the same time gave no indica-
tion that the consumption of small amounts of fluoride produced
any harmful physical effects.
FLUORIDATION OF WATER
363
Controlled Avater fluoridation study projects were then begun in
1945 in Grand Rapids, Mich. ; Newburgh, N. Y. ; Brantford, Ontario,
and later in several other cities. These projects were designed to
determine whether a purposefully fluoridated drinking water would
produce the same beneficial effect as a naturally fluoridated one. A
corollary purpose was to gather experience on the mechanical prob-
lems of adding and controlling the fluoride concentration in a water
system.
The results from these fluoridation study projects have amply
demonstrated that the supplementation of a fluoride-deficient water
supply is a practical, safe, effective, and an economical procedure. In
view of these facts, in April 1951, the Surgeon General indicated that
the Public Health Service endorsed the fluoridation of public water
supplies. . -IT
Let me consider now the specific dental benefits associated with the
ingestion of a proper concentration of fluoride. From chart 1, shown
to my right, here, you can see the actual change effected by fluori-
dation.
Chart 1
Decayed, Missing £- Filled Teeth* Per Child
( FLUORIDE e- NON-FLUORIDE COMMUNITIES )
16-1 \ ) ] 1 \ 1 1 1 ' 1 1 r rl6
The top line represents the amount of tooth decay experienced by
children living in Grand Rapids, Mich., before that city added fluoride
to its water supply, that is, before 1915. It shows a progressive
increase in dental caries at the rate of about a tooth each year. This
rate of increase continues incidentally, until adulthood is reached.
The bottom line indicates the level of tooth decay in children from
Aurora, 111., whose drinking water contained 1.2 parts per million of
naturally occurring fluoride. As you can see, decay occurs in these
children at a considerably lower level. The contrast shown in this
48391—54-
-24
364
FLUORIDATION OF WATER
chart has been confirmed by observations on thousands of children
in communities throughout the United States.
The impact of fluoridation on Grand Rapids children is shown in
chart 2.
Chart 2
Decayed, Missing £• Filled Teeth* Per Child
NINE YEARS AFTER FLUORIDATION (6RAND RAPIDS. MICHIGAN)
^ 8
s 4
"PERMANENT TEETH
Tlie center line represents the amount of tooth decay observed in
Grand Rapids children in 1953, 9 years after fluoridation started. It
has been superimposed upon the first chart. You can see how very
closely the level of tooth decay in Grand Rapids now approximates
that in Aurora, especially in the younger age groups. Children 11
years of age or younger showed the greatest benefit. However, it
is interesting to note that children who were 3 to 7 years of age at
the start of fluoridation and who are now 12 to 16, also acquired a
considerable amount of protection.
Another of our studies produced evidence that the dental protec-
tion of fluoridation continues throughout life.
In chart 3 you can see the difference in the level of tooth decay in
adults residing in Colorado Springs, Colo., who were served by a
water supply containing 2.5 parts per million of fluoride, compared
with the tooth decay observed in adult residents of Boulder, Colo.,
which has a fluoride-free water supply. It is apparent that those
persons living in Colorado Springs continue to have about one-third
the tooth decav found in adult residents of Boulder.
FLUORIDATION OF WATER
365
Chart 3
Decayed, Missing t Filled Teeth Per
(FLUORIDE e. NON-FLUORIDE COMMUNITIES)
Adult
25
20
BOULDER
(NO FLUORIDE)^,,.
.•••
20-24
25-29
>•»»»»»»»»»••»»»»•
COLORADO SPRINGS
(FLUORIDE)
r25
30-34
AGE GROUPS
35-39
■20
10
40-44
Chart 4
Missing Teeth Per Adult
(FLUORIDE AND NON-FLUORIDE COMMUNITIES)
20-24
25-29
30-34
AGE GROUPS
35-39
40-44
\
366
FLUORIDATION OF WATER
The difference in the prevalence of tooth decay greatly influences
the number of teeth lost. This is demonstrated in chart 4, showing
that adults of Colorado Springs have lost only about one-third as
many teeth as residents of Boulder.
The evidence presented in these four charts exemplifies the vast
amount of scientific data which demonstrate the dental benefits ac-
cruing to persons who have ingested fluoride in their drinking water
throughout life.
In short, the value of water fluoridation can be simply stated : It
prevents tooth decay among children by as much as two-thirds. It
cuts down tooth loss in adults by an even greater amount.
Now, Mr. Chairman, I should like to talk about our research on
the safety of the procedure. Naturally, at the time the fluoridation
of water supplies was first considered, the safety of the procedure
was of vital concern. Let me cite some of the more important studies
and observations which have demonstrated conclusively that the ad-
dition of small amounts of fluoride to a water supply is safe.
First of all, as I have noted, fluoride is universally present in the
earth's soil, its plants and its animals, including man, and in all water
supplies wdiich come in contact with the earth's surface.
Chakt 5
Towns Using Naturally Fluoridated Water
( 0.7 PPM OR MORE OF FLUORIDE )
This map (chart 5) will give you some idea of the number of com-
munities which normally have at least 0.7 parts per million or more
of fluoride in their drinking water. The dots on the map represent
some 1,200 communities whose people, about 4 million of them, have
been consuming water with close to or above the recommended con-
centration of fluoride for many years. An additional 60 million have
been drinking water with some fluoride — less than ideal — but still
measurable. The consumption of fluoride-bearing water was never,
therefore, uncoixmion.
FLUORIDATION OF WATER 367
None of us has ever liad a completely fluoride-free diet. The ma-
jority of foods found on the average American table contain from
0.2 to 0.3 parts per million of fluoride. Seafoods and tea are quite
high in fluoride content. Exclusive of drinking water, the average
diet in the United States provides a total intake of 0.2 to 0.3 milligram
of fluoride daily.
It is thus clear that all of us consume a certain amount of fluoride
every day. The addition of fluoride to a fluoride-deficient water
merely adds a controlled and very minute amount to our daily intake.
Another important point is that the dissolved particles of fluoride
in a water supply are identical whether they come from fluoride-
bearing soil, subterranean rock, or from a fluoride compound added
mechanically in a water plant. All fluoride ions, regardless of source,
are the same chemically, and in their physiological action. This is a
basic and elementary fact which has been demonstrated in the labora-
tory, and in studies on both animals and humans.
Among our principal concerns with the safety of fluoridation is
the ability of the body to handle at all times small amounts of fluoride
by assimilation or excretion. The kidney is the organ primarily in-
volved in the elimination of ingested fluorides. In general, a person
will excrete in the urine almost all of the fluoride ingested. Since
this is a key point in any consideration of the safety of fluoridation.
Dr. Zipkin of our National Institute of Dental Research will discuss
in more detail the efficient manner in which the body handles fluorides.
Dr. Zipkin?
Dr. Zipkin. Mr. Chairman and members of the committee:
I should like to comment very briefly on several specific points :
(1) The fluoride content of foods; (2) the effect of fluoride on bone
fractures and bone development; (3) the urinary excretion of fluoride,
and (4) the effect of low-level fluoride ingestion in animals.
To help make these points clear, I have prepared several charts
which are attached to my prepared statement. These are numbered
serially, and I shall refer to them from time to time.
The fluoride content of foods: Practically all foods contain some
fluoride. Thus, in studying fluoride intake, it is important to con-
sider the amount ingested from food as well as from drinking water.
In fact, as Dr. Knutson has pointed out, no one has so far been able to
produce a diet for humans — or for animals — which is fluoride-free.
Chart 1 shows that a number of foods contain more than 0.2 part
per million of fluoride. Honey, cocoa, spinach, and apples have ap-
proximately 1 part per million. Teas contain 30 to 60 parts per mil-
lion. Continuing with chart 2, we find that some meats and seafoods
have a fluoride content up to 27 parts per million. A pound of canned
mackerel, for instance, may provide as much fluoride as 15 quarts of
drinking water containing 1 part per million of fluoride, or 12 to 15
milligrams.
The daily fluoride intake from food and water has been estimated
at from 0.5 to 2 milligrams, varying with the age of the individual.
This can be seen in chart 3.
The effect of fluoride on bone fractures and bone development:
The possibility that the use of water containing fluoride might pre-
dispose the individual to bone fracture has received careful study
by our staff at the National Institute of Dental Research. 1,450 high-
368 FLUORIDATION OF WATER
school boys, 15 to 17 years of age, and 1,600 young men, 18 to 25 years
of age, were questioned indiviclually concerning their fracture exper-
ience. Each of these individuals had consumed domestic water con-
taining up to 5 parts per million of fluoride. The data for the high
school boys are in chart 4, and that for the young adults are in chart
5. They show no unusual fracture experience.
Another study of this kind involved the review of the physical ex-
amination records for 1,000 men at the Lubbock, Tex., Induction
Center. This group included persons who had been exposed to drink-
ing water containing more than 5 parts per million of fluoride. This
survey showed no clifferences in fracture experience which could be
related to the fluoride concentration in the water. For example, the
incidence of fractures among persons from Lubbock, where the water
contained 5 parts per million of fluoride, was not higher than the in-
cidence of fractures among individuals from Washington, D. C,
where the water was virtually fluoride-free.
A study has also been made of the relation of fluoride in drinking
water to the development and calcification in the bones of the hand.
X-rays were used to compare the hands of two large groups of chil-
dren. The first of these groups consisted of nearly 1,300 children,
7 to 14 years of age, who had a history of continuous residence in
Amarillo and Lubbock, Tex., and who had consumed domestic water
containing 3 to 6 parts per million of fluoride. The second group
consisted of about 800 children of the same age from Cumberland,
Md., where the water was virtually fluoride-free. The results are
presented in chart 6. No differences were observed when the calcifi-
cation and skeletal development rates were compared with recognized
standards. This clearly demonstrated that bone development and
calcification rates are the same among children in high and low fluoride
areas.
The urinary excretion of fluoride: The facility with which the
kidneys eliminate fluoride may be seen in the data collected from the
Grand Rapids, Mich., study initiated in 1945, from the study in Mont-
gomery County, Md., started in 1951, and from the data collected in
Aurora, 111.
Montgomery County adults, as shown in chart 7, eliminate 1 part
per million of fluoride in the urine, which corresponds to the 1 part
per million fluoride content of the drinking water. Fluoride excre-
tion for children of this county up to 14 years of age is at a somewhat
lower level, but will equal 1 part per million fluoride in about 4 years,
as can be seen from the Grand Rapids data in chart 8.
In the third study, children of comparable age from Aurora, III.,
drink water containing 1 parts per million of naturally occurring
fluoride, and they excrete the same concentration in the urine.
While all three of these communities have a similar fluoride con-
centration in their water supplies, it is important to note the differ-
ences in source of the element. Grand Rapids adds sodium fluoride ;
Montgomery County adds sodium fluosilicate; and Aurora uses
water which contains fluoride naturally. In all three communities,
the excretion of fluoride in the urine is similar, regardless of the
source of the fluorine. It may therefore be concluded that whether
the fluoride occurs naturally or is added, the body excretes fluoride in
the same manner.
FLUORIDATION OF WATER 369
The effect of low-level fluoride ingestion in animals : A laro^e body
of knowledge has been accunuilated on factors influencing the deposi-
tion of fluoride in the bones of the animal organism. I should like
to present the major findings of some of these studies which shed
light on the manner in which the body handles a low level of fluoride
in the drinking water. These experiments, using the white rat as the
experimental animal, were designed to answer three questions.
1. How is fluoride deposited in the bones and teeth when exposure
has occurred over a long period of time? Eats receiving 10 parts
per million of fluoride deposited this element in the bones up to an
age beyond which no further accumulation of fluoride occurred. As
indicated in chart 9, the oldest rats w^ere 420 days old, which is
equivalent to roughly 35 years of age in the human. This experiment
approximates a situation in which human beings have been reared
on a fluoridated drinking water. From these findings, it would be
expected that persons receiving a low level of fluoride in their water
would deposit this element up to a certain age beyond which no
further deposition would take place.
2. How is fluoride deposited in the bones and teeth wdien the initial
exposure to waterborne fluoride occurs at varying age ? In this study
rats of different ages, with no previous exposure to fluoride, received
similar quantities of fluoride in their drinking water. As can be seen
in chart 10, the amount of fluoride deposited in bone varied substan-
tially according to the age of the rat. Older rats deppsited appre-
ciably less than the younger ones. The range of age in the rats — from
30 to 330 days — is comparable to a range of 3 to 30 years in the human.
From this finding, it would be expected that when a community
water supply is fluoridated, older individuals would deposit less
fluoride in their bones than do children. It should be remembered
that the deposition of fluoride in the bones of children is completely
compatible with good health, as evidenced by X-ray examinations
of the hands, forearms, and legs of children in Newburgh, N. Y., six
years after the start of water fluoridation. These X-rays showed
no differences which could be attributed to ingested fluoride, and, in
addition, blood counts and urinalyses revealed no evidence of any
untoward effects.
3. Does fluoride affect the rate of growth of newly forming bone?
This seemed to us to be another important question to be answered
concerning the effects of fluoride. Elongation of a long bone, such as
the tibia or shin bone, occurs at both ends. One of our studies in rats
involved measurement of the rate of growth of both ends of the tibia.
The data are charted in chart 11. Some of the rats received distilled
water, and some received 10 parts per million of fluoride. There was
no difference in the rate of growth at either the upper or the lower
end of the tibia as a result of fluoride ingestion.
I should like now to summarize the five major points brought out
in my statement.
1. Many foods contain appreciable amounts of fluoride. This is
particularly true of teas, meats, and fish.
2. Even with fluoride in water at level 4 to 5 times greater than
that advocated for caries prevention, there was no effect on bone
development or fracture experience.
3. Both children and adults excrete 1 part per million of fluoride
in the urine when the drinking water contains an equal concentration
370 FLUORIDATION OF WATER
of the element; moreover, such excretion by the kidney is the same
for both naturally occurring and added fluoride.
4. It appears that bones gradually lose their capacity to store
fluoride; after an initial adjustment to fluoride ingestion, a constant
level is reached, and no further appreciable deposition occurs.
5. Low concentrations of fluoride had no effect on the growth rate
of the tibia.
This statement has touched ujjon only a small fraction of the
biochemical studies on fluoride metabolism which have been reported
in the lituerature. These studies support a convincing body of scien-
tific evidence that fluoride, at a concentration of 1 part per million
in drinking water, presents no health hazard.
Mr. Heselton. Before we leave Dr. Zipkin's statement, I wonder if
I could ask a question ?
INIr. Hale. Perhaps these gentlemen would want to proceed as a unit
with their whole testimony. However, if you have a short ques-
tion
Mr. Heselton. Where you say: "Many foods contain appreciable
amounts of fluoride. This is particularly true of teas, meats, and fish,"
as I recall it, the only specific food that you mentioned was a pound
of canned mackerel, which "may provide as much fluoride as 15 quarts
of drinking water containing 1 part per million of fluoride, or 12 to
15 milligrams."
Have you available similar analysis of other kinds of teas, and fish,
and meats, that you could provide for the committee ?
Dr. ZiPKiN. Yes, sir. I think figure 2 has an itemized list of the
content in parts per million of shrimp, sardines, salmon.
Mr. Heselton. That is all.
Mr. Priest. If the chairman will permit one further question.
Doctor, I assume that according to your statement, tea contains 30
to 60 parts per million. In other words, if I might put it this way,
what would a glass of tea made from water that is not possessed of
fluoridity contain as compared with a glass of water with 1 part per
million added to the water ?
Dr. ZiPKix. I think I understand your question. I think your inter-
est is in how mucli fluoride is in, how much fluoride is present in a cup
of tea if you drank it. Approximately a tenth of a milligram of fluo-
ride would be present in a cup of tea
Mr. Hale. That would depend on how strong the tea was, wouldn't
it?
Dr. ZiPKiN. This is an average of a number of teas, and if you hap-
pened to pick up a pound of tea a cup of the brew should fall within
this range and represent roughly a tenth of a milligram.
Dr. Knutson. I would like to turn to a consideration of some of
the studies which have been done on the general reaction of the body
to fluoride ingestion, specifically as it relates to the development of soft
tissue pathology and certain acute and chronic diseases.
In a comprehensive 10-year evaluation of the possible physical effects
of continued ingestion of a water with a naturally high fluoride con-
tent, staff members of the National Institute of Dental Research con-
ducted medical examinations on several hundred persons residing in
Bartlett and Cameron, Tex. Bartlett has 8.0 parts per million of
fluoride in its supply ; Cameron has 0.4. The clinical and laboratory
FLUORIDATION OF WATER 371
findings showed no difference between the towns durin<^ the 10-year
period, except that mottled enamel was common in Bartlett. Dr.
Leone, the principal investi^^ator on this survey, is here with me. In
his discussion of the o;eneral medical aspects of fluoride inj2;estion, he
wall present the details of the Bartlett-Cameron study. Dr. Leone will
also discuss mechanisms by which the body quickly and effectively
reduces the fluoride level of blood and soft tissues.
Dr. Leone ?
Dr. Leone. Dr. Knutson, Mr. Chairman, members of the committee,
there is much evidence that prolono:ed inp;estion of fluorides is not in-
jurious to health. Some of the evidence has been f^ained indirectly —
for example, throu<^h comparative mortality studies. In this state-
ment, I wish to review some investigations that have established the
safety of fluoride ingestion through direct measurement of the medical
effects.
The Bartlett-Cameron study : The principal study I should like to
discuss was conducted by the United States Public Health Service in
the towns of Cameron and Bartlett, Tex., over the 10-year period,
1913-53. The purpose was to detect, in a readily observable popu-
lation group, any effects of long-continued ingestion of water con-
taining an unusualy large amount of fluoride.
Bartlett was selected as the experimental town because the natural
fluoride level of the local water supply was one of the highest in the
Nation — 8 parts per million of naturally occurring fluoride. This
level, you will recall, represents 8 times the amount recommended for
caries prevention. Cameron, comparable in size, location and other
characteristics, was the control town with 0.4 part per million of
fluoride in the water supply.
The 237-study participants were about evenly distributed between
the 2 towns. They were persons who had resided in their respective
communities for a minimum of 15 years prior to 1943. The average
length of residence, at the end of the study period, was 37 years for
the Bartlett group ; 38 5^ears for those in Cameron. Ages of the par-
ticipants ranged from 15 to 68 years at the beginning of the study.
Procedure : Each participant, following a review of his medical
history since birth, received in 1943 a complete medical and dental
examination. Attention was given to the eyes, ears, kidney, liver,
bones, thyroid, cardiovascular system, and other sites. The studies
included appropriate X-rays and laboratory tests on blood and urine.
The entire battery of clinical examinations and laboratory tests, to-
gether with a review of medical experience during the 10-year period,
was repeated in 1953 for all the original participants, with the excep-
tion of 18 deceased. The staff was even able to reexamine those who
had moved from their respective towns.
The study was carefully planned and conducted to permit a detailed
comparison of the health status of the two groups in 1943 and 1953.
Not only could persons be compared within and between the groups,
but a single individual could be compared with himself over a period
of 10 years. The study has therefore contributed substantially to
our basic understanding of the clinical effects of excessive fluoride
exposure.
372 FLUORIDATION OF WATER
Findings : Analysis of the data produced the following conclusions :
(1) The medical characteristics of the 2 groups did not differ
more than would be expected for 2 comparable towns without an
excess of fluoride in either water supply ;
(2) The occurrence of mottled enamel, as would be expected, was
significantly greater in Bartlett; and the incidence of cardiovascular
disease was higher in Cameron — an observation unrelated to fluoride
ingestion ;
(3) There was no significant difference between the age-adjusted
death rates in the two towns ;
(4) The 2 groups showed no significant difference over the 10-
year period with respect to changes in blood pressure, arthritic condi-
tions, eyes, thyroid disorders, hearing, tumors or cysts, bones and bone
fractures, and urinary system; all of which are shown in table 1, of
which you have a copy attached to this statement.
(5) The only difference in frequency rates of abnormal laboratory
findings was in the counts of white blood cells, which tended to be
higher in Bartlett. (See table 2.) This diiference, when viewed in
light of clinical circumstances, does not suggest an association with
fluoride intake.
When these findings for the 2 groups are critically reviewed, it
is clear that the only difference attributable to the excessive fluoride
exposure is dental mottling in Bartlett.
Tissue studies : I should like also to call your attention to a long-
term investigation on human tissues. It is another of the Public
Health Service series of related studies on the effects of excessive
fluoride ingestion. The findings are derived from microscopic and
chemical analyses of bone and soft tissues taken at autopsy from per-
sons who had ingested as much as 8 parts per million of naturally oc-
curring fluoride in drinking water over a long period. In summary,
this prolonged ingestion produced no detectable changes in structure
nor impairments of function.
These findings are comparable with those from studies on animals.
Only when highly toxic dosages are fed to animals can early effects
of fluoride be detected. It is important to keep clearly in mind the
difference between such concentrations and the 1 part per million of
fluoride per day recommended for the prevention of dental caries.
An interesting case from our autopsy series illustrates the type of
source material available to substantiate our conclusions on the
physiological effects of fluoride. The case is uniquely important in
that it permits a direct evaluation of fluoride effect on human tissues.
One of the participants of the 10-year study, a Bartlett resident for
50 years, had a stroke at age 78 and died shortly after the 1953 re-
examination. The patient had been in excellent health ud to the time
of the stroke. For more than 10 years, she had had high blood pres-
sure, which was related to a generalized arteriosclerosis, a condition
common in persons of her age. The patient was otherwise without
notable findings upon physical examination.
The patient's entire medical history and examination findings were
reviewed. The X-ray survey of her bones, 1943 and 10 years later,
gave evidence of an increase in bone density and coarseness of the in-
ternal bony structure, but there was no indication of physical im-
FLUORIDATION OF WATER 373
puirment, deformity, change in bone size, or any other damage not
in keeping witli hor age. We liave good evidence, incidentally, that
such increased bone density and coarseness is beneficial, particularly in
aged persons.
A complete autopsy was performed, and specimens were obtained
from the skeletal system, heart and blood vessels, stomach, kidneys,
brain, and from other soft tissues for microscopic examination and
chemical analysis.
On analysis of the bone, the fluoride content in parts per million
was 10 times that observed ordinarily in human bone from non-
fluoride regions. This parallels the desirable increase in bone density
previonsly mentioned. Microscopic examination of the soft tissues
showed no impairment — no changes that could be associated with
the ingestion of 8 parts per million fluoride for over 50 years.
The work of other investigators indicates that no soft tissue changes
are observed even after prolonged ingestion of 300 times the amount
of fluoride regarded as optimal for caries prevention.
Fluoride excretion : There is currently available an extensive body
of knowledge on kidney function, particularly with regard to the ex-
cretion of halogens, the family of elements to which fluorine belongs.
Dr. Zipkin has already referred to the kidney's efficiency in eliminat-
ing fluoride. This efficiency is so high that the halogens continue to
be excreted even in the presence of severe heart disease or kidney
damaije. In fact, a patient with impaired kidney function would
probably succumb to uremic poisoning long before the kidney lost
its ability to transfer fluorides.
The studies I have reported are among the most recent and reliable.
They yield direct, conclusive information on the medical aspects of
fluoridation in humans in good health and those who are not. The
conclusion to be drawn from all these studies, whicli utilize a wide
variety of medical approaches, is that fluoridation of public water
supplies at the recommended level (1 part per million) is absolutely
safe.
Dr. Knutson. Some years ago there was a flurry of excitement
about a possible relation of fluoride ingestion to cancer in mice, based
on a preliminary report of observations made at the University of
Texas. Subsequent studies gave no evidence of such a relationship.
On the contrary, reports by Dr. H. S. Fleming of Yale University
and Dr. W. D. Armstrong of the University of Minnesota suggest
that consumption of fluoride-bearing water tends to retard the develop-
ment of tumors in mice.
In an interesting study, Dr. M. M. Black and his coworkers at the
New York Medical College fed fluoride to 70 persons with incurable
illnesses, largely cancer. The amounts of fluoride given to these per-
sons for a period of 4 to 6 months ranged from 80 to 400 milligrams
a day. The average adult dose was 320 milligrams daily — the equiva-
lent of 320 times the amount recommended for water fluoridation.
This extraordinarily high intake did not produce any observable acute
or chronic toxicity. Microscopic examinations of organs after death
from the illness failed to reveal any damage to soft tissues. Although
the elements of this experiment are rather far removed from ingestion
of water containing the concentration used for control of dental decay,
374
FLUORIDATION OF WATER
it is mentioned to show that surprisingly large quantities of fluoride
have been taken into the body, and under very careful scrutiny over
long periods of time, without detectable physical effects.
Another approach to measuring the influence of fluoride ingestion is
to evaluate mortality data in relation to exposure to fluoride-bearing^
water. Studies of the incidence of deaths from certain diseases in
fluoride and fluoride-free areas reveal no pattern which would sug-
gest that consumption of fluoride-bearing water influences mortality
in these communities.
Chaet 6
Deaths* From Five Causes In Fluoride
& Non-Fluoride Cities, 1949-1950
FLUORIDE CITIES
NON-FLUORIDE CITIES
400
300
20O
-100
CANCER
'ADJUSTCO FOR AGE, AACE ANO SEX
INTRA-CRANIAL
LESIONS
NEPHRITIS
CIRRHOSIS
OF THE LIVER
The next chart shows the distribution of mortality rates from
heart disease, cancer, intracranial lesions, nephritis, and cirrhosis of
the liver in 32 cities in the United States with fluoride and 32 with
fluoride-free water supplies. As you can see, no discernible differ-
ence exists between the mortality rates for these two groups of cities.
These data have been verified and supported by observations made
independently in Wisconsin, Illinois, and Texas, and in many of the
areas where fluorides occur either in excess or in optimum concentra-
tions.
In a continuing evaluation of mortality data obtained in our study
project in Grand Kapids, Mich., we found no indication of changes
in mortality when compared with those from the control city of
Muskegon and with data from the Nation as a whole.
In the next four charts (7-10) comparison of mortality rates for
Grand Kapids, Muskegon, and the Nation, for a period just prior ta
and during fluoridation in Grand Rapids — Muskegon did not have
FLUORIDATION OF WATER
Chaet 7
375
Deaths* From Nephritis
U.S., GRAND RAPIDS AND MUSKEGON (1943-1950)
1943 1944 1945 1946 1947 1948 1949 1950
YEAR
"ADJUSTED FOR AGE, RACE E-SEX
Chabt 8
Deaths* From Cancer
U.S, GRAND RAPIDS AND MUSKEGON (1943-1950)
1943 1944 1945 1946 1947 1948 1949 1950
YEAR
'adjusted for A(E, race e. SEX
376
FLUORIDATIOX OF WATER
Chakt 9
Deaths'^ From Heart Disease
U.S, GRAND RAPIDS AND MUSKEGON (1943-1950)
400-
350
z
o
H 300
o.
0 250
o
o
1 200-
o
UJ
I 150-
en
^ 100-
UJ
o.
CO
§ 50H
MUSKEGON
(NO FLUORIDE)
•^-^
GRAND RAPIDS
,,. (FLUORIDE SINCE IMS)
-4001
-350'
300'
-250.
-aoo*
-150
-lOOi
-50<
1943 1944 I94S 1946 1947 1948 1949 IS50
YEAR
"adjusted FOK AGE.KACi c- SEX
Chart 10
Deaths* From Intra-Cranial Lesions
U.S., GRAND RAPIDS AND MUSKEGON (1943-1950)
140
120
100
80
60
40
20
I40'.
I
MUSKEGON
^^^^_ (NO fluoride)
^^'^ I ••. GRAND RAPIDS \
■"^ ••• ••.(FLUORIDE SINCE 1945) \
..••>ioo
120
1943 1944 1945 1946 1947 1948 1949 1950
YEAR
"ADJUSTED FOR AGE, RACE AND SEX
FLUORIDATION OF WATER
377
fluorides in their water supply — are sliown first for nephritis. And
you will notice the variation around this principal line for the United
States as a whole. However, those are variations Hiat are to be ex-
pected for deaths in a community of the size of Muskegon, for exam-
ple, of 50,000 population, but they are not significantly different than
those for the Nation, even though you will note that for Grand Rapids
the rates are fairly consistently below those for Muskegon.
Next, for cancer, again no significant difference between Grand
Rapids and the control city of Muskegon.
Next, for heart disease, again no difference between those two com-
munities.
And last for intracranial lesions
Mr. Hale. Will you explain in passing what an intracranial le-
sion is ?
Dr. Knutson. I am a dentist. I have Dr. Leone here with me,
who is a physician. I will pass that question to Dr. Leone.
Dr. Leone. Intracranial lesions in this i)articular case pertain to
those instances where lesions are associated Avith what we call neo-
plasms, forms of cancer; or other cerebral lesions which occur in the
skull.
I am sorr}^ if I haven't made that clear. Intracranial lesions would
be anything occurring above the jaw line, let us say, and can be of the
natui'e of a stroke. Theie are many different types. That is why I
use the general term. *
Mr. Hale. For example, would a brain tumor be an intracranial
lesion ?
Dr. Leone. That is right, sir.
Chart 11
Communities Using Fluoridated Water
(1945-1953)
378 FLUORIDATION OF WATER
Dr. Knutson. No significant differences can be seen in deaths from
these causes either before or after 1945, when fluoridation was started
in Grand Rapids.
As you know, many American communities have already instituted
controlled fluoridation. Chart 11 shows the number of communities
which have decided to supplement their water supply, and the popula-
tions residing in these communities. The numbers in the red circles
are the number of communities. You will note that in 1950 there
were 850 communities. The scale on the right is the population in mil-
lions. In other words, at the end of 1953, 850 communities were fluo-
ridating their water supplies, serving approximately 16 million
people.
There has been a slow but consistent increase in the use of this pro-
cedure since 1945. In the United States today there are about 17 mil-
lion people in over 900 communities consuming water which has been
supplemented with fluoride. These communities are using in a precise
manner something which nature has distributed irregularly.
Now, I would like to discuss briefly the role of the Public Health
Service with respect to the Nation's dental health problems in gen-
eral, and to fluoridation in particular. Dental disease is of consider-
able public health significance. Probably no other disease category
affects so large a proportion of the population. Dental defects ac-
counted, for example, for 21 percent of the rejections among the first
2 million men called for service in World War II.
The most important single type of dental disorder is dental caries,
or tooth decay. Neglect and the vast backlog of accumulated needs
have led to loss of teeth, to impaired dental function, and to general ill
health.
Although less than one-third of the American people receive ade-
quate dental care, the economic burden of dental disease is a sizable
one. In 1953, the American people spent about $1.6 billion for dental
care, about one-sixth of the total expenditure for personal health
services in the Nation. This sum, an all-time high in dental expendi-
tures, is but a fraction of the estimated amount needed to provide
adequate care for the American people. Even if there were an un-
limited amount of money available for dental care, there are simply
not enough dentists to furnish the required volume of services. Thus,
there is little possibility that the Nation's dental health problem can
be solved in the near future solely by increasing the correction of ex-
isting defects.
This points up the needs very sharply. There are several, includ-
ing the need to conduct research into the basic problems of dental
diseases and disorders, to stretch the limited supply of dental man-
power, and to use all available resources for a maximum contribution
to dental health. Most prominent, however, is the need to develop,
perfect, and apply more effective methods of preventing dental
disease.
As you know, the Public Health Service is charged by law to con-
duct health research, to develop and test measures for the preven-
tion and control of disease, to help States and communities apply
those measures, and to disseminate public health information. In
accordance with this mission, we have been active in each of the areas
of need I have just mentioned. We have conducted studies, for ex-
FLUORIDATION OF WATER 379
ample, on the use of dental assistants and multiple chairs in the den-
tist's office. This has enabled dentists to increase their productivity
and to treat more people. We are doing research on diseases of the
gums and the bony supporting structures. Through State and local
health agencies, we work with schools and clinics to encourage pe-
riodic dental examinations, to apply proper methods of mouth
hygiene, and to promote desirable dietary habits.
In addition, as in all public health programs, we provide technical
and advisory services for official health agencies. In all of this work,
we attempt to translate new knowledge into practical public health
procedures. Our job, in other words, is to help apply research and
laboratory findings for the benefit of all the people.
One such finding, as I have pointed out, is fluoridation. This meas-
ure has a great potential for improving health, lowering dental bills,
and for reducing the Nation's dental needs to manageable propor-
tions. Consequently, public health workers have given their whole-
hearted endorsement to this i)rocedure. In the Public Health Service,
as in liealth agencies throughout the Nation, fluoridation is one part
of a diversified and balanced approach to meeting our total dental
health needs.
Fluoridation followed the typical pattern in the development of a
public health technique. It met all the tests. It was studied over a
long period of time, both by research workers in the Public Health
Service and by other investigators. It was subjected to intensive field
testing for safety and practicability. Its effects were demonstrated,
checked, and rechecked. Practical methods for its application were
worked out and perfected in considerable detail. And it finally be-
came part of the public health armamentarium, along with other pre-
ventive techniques.
The responsibilities of the Public Health Service were clear: to
make the facts about fluoridation known to State and local health
agencies, and to provide them with technical assistance in the ap-
plication of this important public health advance. In view of the
convincing amount of scientific evidence, we could do no less and still
meet our obligations as a national health agency.
As with all public-health procedures, the decision on fluoridation
rests and, in our opinion, should continue to rest, with the local com-
munity. In public-health works, it could not be otherwise, nor would
we wish it to be otherwise. All local health activities, from the op-
eration of clinics to the enforcement of sanitary regulations, are the
res])onsibilities of the community. We believe that there is no justi-
fication for any Federal intervention into local health matters. We
feel certain that in fluoridation, as in other health matters, the combi-
nation of professional public health leadership and enlightened citizen
interest will insure the decision that will enable communities to go
forward in health.
To sunnnarize, Mr. Chairman, we cannot accept the premise that
fluoridation of public water supplies constitutes a hazard to public
health. On the contrary, we believe that its safety has been clearly
established and that its potential for improving dental health war-
rants the serious consideration of all communities concerned with
progressive health measures. We believe, however, that the determi-
48301—54 25
380
FLUORIDATION OF WATER
nation of proper action in this matter can and should be left for each
community to decide for itself, and that no Federal controls are neces-
sary or desirable. We therefore recommend against enactment of
(Charts and tables referred to are as follows :)
FiGLTBE 1. — Fluorine reported in dry substance of food
Fluorine parts
per million
Honey 1. 00
Cocoa . 50- 2. 00
Milk chocolate . 50- 2. 00
Chocolate (plain) . 50
Tea (various brands) 30.00-60.00
Cabbage . 31- . 50
Lettuce .60- .80
Spinach 1. 00
Tomatoes .60- .90
Turnips . 20
Carrots . 20
Potato (white) . 20
Potato (sweet . 20
Apples . 80
Pineapple (canned) . 00
Orange . 22
FiGXJRE 2. — Fluorine reported in food as consumed
Fluorine parte
per million
Pork chop 1. 00
Frankfurters 1. 70
Round steak 1. 30
Oysters 1. 50
Herring (smoked) 3. 50
Canned shrimp 4. 50
Canned sardines 7. 30-12. 50
Canned salmon 8. 50- 9. 00
Fresh fish 1. 60- 7. 00
Canned mackerel 26. 89
Figure 3.
-Estimated fluorine ingested in food and in drinking water containing
1 part per million fluorine
f Milligrams]
Age (years^
From fluoride
water
From food
Total daily
1 to3
0. 4-0. 5
.5- .8
.7- .9
. 8-1. 2
0. 03-0. 30
. 04- . 40
. 05- . 45
. 06- . 60
0. 4-0. 8
4 to 6 -
. 6-1. 1
7 to 9 - .-
. 7-1. 4
10tol2 -
.9-1.8
I
FLUORIDATION OF WATER
381
Figure 4
DISTRIBUTION OF BONE FRACTURE EXPERIENCE
NUMBER PER ONE HUNDRED BOYS
FLUORINE (RRM.) IN
WATER
GALESeURG 1.9
MONMOUTH 1.8
AURORA 1.2
ELGIN 0.5
aUINCY 0.1
WAUKEQAN 0.0
WASHINGTON .0
O.C.
TZZZZMH.
^^szzz^mun.
O 5 10 15
NUMBER PER 100 BOYS
20
25
30
ARM, WRIST OR ELBOW e2ZZ3 COLLAR BONE C
^^ LEG, KNEE OR ANKLE EISI3 NOSE
] OTHER MEMBERS
Figure 5
DISTRIBUTION OF BONE FRACTURE EXPERIENCE ACCORDING TOTHTNUMBER
PER ONE HUNDRED MEN
FLUORINE (PPM.)
IN WATER
AMARILLO *
a LUBBOCK 3.8-5.1
TEXAS "A" 2.5-5.2
TEXAS "B" 1.5-2.0
TEXAS 'A'S'S" 2.5-5.2
TEXAS •C"6"D"
a BIG SPRING 0.5-1.5
TEXAS 'Ca'CT 0.3-1.2
TEXAS 05-5.2
OKLAHOMA 0.5-1.0
RURAL INDIANA .0-0.5
INDIANAPOLIS 0.2
WASHINGTON DC. 0.0
NEW HAMPSHIRE 0.0
0 5 10 15
NUMBER PER 100 MEN
HBI ARM, WRIST OR ELBOW Y/Z/A COLLAR BONE Q
tXXXXl LEG, KNEE OR ANKLE fTTTvI NOSE
J OTHER MEMBERS
382
FLUORIDATION OF WATER
FlOXTBE 6
f. in wottr
<ppm.)
0.1
3.5
to
4.5
3.3
to
6.2
3.3
to
6.2
Univ. of Chicogo
Normols
Cumber lond, Md.
Lubbock, Texos
Amarillo, Texas
Mottled Enamel
Absent or mild
Lubbock a Amarillo
Mottled Enamel
Moderate or severe
Sei
M
F
M
F
M
F
M
F
M
F
M
F
No. cases
700
700
368
401
330
3 60
267
324
145
194
4 19
4 50
MEAN CARPAL OSSIFICATION RATIO
1
1
]
■ 1
■■■■■■ ■ , ■ v.v ,■ ■■ -" ■ ■■ ■
1
1
:■■:• ■■■'•:■)
1
■:■■::■■:■:•-:•■":■-.' i
■■ \
... .. 1
1
..:.--■:.:.■: 1
1
. ' :' 1
Lubbock a Amarillo
1 1
RATIO XI 00 60 70 80 90
SKELETAL AGE RATING
0.1
3.5
to
4.5
3.3
to
6.2
3.3
to
6.2
Univ. of Chicogo
Normols
Cumber lond, Md.
Lubbock, Texas
Amor illo, Texos
Mottled Enamel
Absent or mild
Lubbock a Amarillo
Mottled Enamel
Moderate or severe
Lubbock a Amarillo
M
M
M
M
M
M
350
350
368
401
330
360
267
324
145
194
4 19
4 50
1
,, 1
1
I
1
5
' '■: -1
' 1
1
I
...'■.: ■:'.■.":■ y.
]
■' , ' "■ : 1
1 1
FLUORIDATION OF WATER
383
FiGUBE 7
FLUORINE CONTENT OF URINE IN RELATION TO
FLUORINE IN DRINKING WATER
MONTGOMERY
COUNTY, MD.
PPM F AS Na2SiFg
1.2
• AGE 30-39 YRS
,--
•
1.0
0.8
4
/•
^ •
AGE 5-14 YRS.
o
Q.
a.
z
o
UJ
z
cc
o
0.6
°Q/
X'
o
3
_l
u.
0.4
0.2
D
10 20 30 40 50 60 70 80 90 100 110
WEEKS AFTER FLUORIDATION
384
FLUORIDATION OF WATER
Figure 8
FLUORINE CONTENT OF URINE IN RELATION TO
FLUORINE IN DRINKING WATER
GRAND RAPIDS, MICHIGAN I PPM F AS No F
0 10 20 30 40 50 60 70 80 90 100 HO
MONTHS AFTER FLUORIDATION
Figure 9
0.20 -
I
< 0.16
UJ 0. 12
Z
CC
§ 0.08
^ 0.04
UJ
U
o.
DAYS 0
ON FLUORINE 0
AGE IKI DAYS 30
60
90
120
150
-
1 1
1 1 1
EXPERIMENTAL
1 1
— ^i-
—
-^ MANDIBLES
-O MOLAR TEETH
&
-
'y>-
^o
-
-
//
i^^
-
^
^
1 1
1 1 1
1 1
"1 1 —
CONTROL
ISO
210
300
330
420
450
FLUORIDATION OF WATER
FiGUBE 10
385
I
V}
< 0.10
u
? 0.08
a.
O
_l -
^ 0.06
»-
Z
tiJ
u
cr o.04|-
UJ
AGE AT START 30
AGE AT END
FlQXmBJ 11
RATE OF LONGITUDINAL GROWTH AT PROXIMAL
AND DISTAL END OF TIBIAL DIAPHYSIS
I.I
-
1 1
1 1
1 1 1 1
1
1.0
-
PROXIMAL,,,,-.^ "
■<r.
0.9
-
^ • '
-
O.B
-
.
^
-
0.7
-
J^
o CONTROL
4 TREATED
-
0.6
-
^
-
0.5
-
/
-
0.4
-
/
-
03
-
/
a
DISTAL
-
02
" /
/^
— «z
0.1
-/^
1 1
1 1
1 1 1 1
1
AGE IN DAYS
386
FLUORIDATION OF WATER
Tarle 1. — Incidence of abnormal clinical findings, 1943-53
[Participants residing in study area for the ten -year period]
Characteristic studied
Arthritic chan ge
Blood pressure:
Systolic 151 mm/Hg and over
Diastolic 100 mm/Hg and over -
Pulse pressure 75 mm/Hg and over
Bone changes:'
Density 2 ^■..'....
Coarse trabeculation . -.-r _'
Hypertrophic
Spurs--
Osteoporosis 1
Bone, increased density (new cases)
Cataract and/or lens opacity
Thyroid
Cardiovascular (except uncomplicated
hypertension
Hearing (decreased acuity)
Tumor and/or cysts
Fractures
Urtn ary tract calculi
Gall stones :
Bartlett
Num-
ber at
risk
Num-
ber ab-
normal
Rate
(per-
cent)
18
31.0
11
15.1
9
12.9
7
9.5
4
5.4
8
10.8
1
1.4
n
6.8
1
1.5
H
10.1
3
4.1
12.5
19.4
15.0
15.0
19.4
0
Cameron
Num-
ber at
risk
Num-
ber ab-
normal
Rate
(per-
cent)
24.7
13.3
18.0
2.5
2.5
7.4
4.9
12.3
14.1
7.3
23.9
12.8
10.9
7.6
15.8
1.2
Signifi-
cant dif-
ference
(P=0.05)
No.
No.
No.
No.
No.
No.
No.
No.
No.
No.
Yes.
No.
No.
No.
No.
No.
1 Bone changes determined bv simultaneous reading of identical views of X-rays taken in 194 3and repeated
in 1953.
- Bartlett: 4 increased density, 3 decreased density. Cameron: 2 increased density.
T-iBLE 2. — Prevalence of ahnormal laboratory and dental findings, 19^3 and 1953
[Participants residing in study area for the 10-year period]
Year
Bartlett
Cameron
Signifi-
cant dif-
ference
(P=0.05)
determination
Number
examined
Number
abnormn]
Rate
(percent)
Number
examined
Number
abn ma
Rate
1 (percent)
Hemoglobin
1943
1953
1943
1953
1943
1953
1943
1953
1943
1953
1943
1953
1943
1953
1943
1953
1943
1953
1943
1953
1943
1953
1943
1953
1943
1953
116
79
34
20
29.3
25.3
121
83
If 37
L26
30.6
31.3
No.
No.
Red blood count
White blood count
Differential count:
Neutrophiles
Lymphocytes
Eosinophiles
79
116
80
116
78
71
78
71
78
71
78
5
25
6
17
11
15
23
2
35
0
6
6.3
21.6
7.5
14.7
14.1
21.1
29.5
2.8
44.9
0.0
7.7
82
121
85
121
82
71
82
71
82
71
82
24
2
5
6
13
1
36
0
14
8.5
19.8
2.4
4.1
8.5
8.5
15.9
1.4
43.9
0.0
17.1
No.
No.
No.
Yes.
No.
Yes.
Yes.
No.
No.
No.
No.
79
31
39.2
83
22
26.5
No.
Serology (S. T. S.)
Dental fluorosis
Urine albumin
Urine glucose- .
79
71
84
88
45
115
77
115
77
9
2
2
34
10
3
5
2
0
11.4
2.8
2.4
38.6
22.2
2.6
6.5
1.7
0
66
71
95
102
64
121
85
121
85
7
3
2
1
1
10
12
4
1
10.6
4.2
2.1
1.0
1.6
8.3
14.1
3.3
1.2
No.
No.
No.
Yes.
Yes.
Yes.
No.
No.
No.
FLUORIDATION OF WATER 387
Mr. Hale. Thank you very much, gentlemen.
Are there questions?
We will place in the record at tliis point a letter of May 27, 1954,
from Congressman HoU'maiL
(The letter referred to is as follows :)
Congress of the United States,
House of Representatives,
Washington, D. C, May 27, Wo.',.
Hon. Charles A. Wolverton,
Chairman, Interstate and Foreign Commerce Committee,
House of Representatives, Washington, D. C.
My Dear Colleague: As I have indicated to you before, I am opposed to
the limitation which H. R. 2341 would impose on the power of local communities
to fluoridate water.
The supporters of H. R. 2341 have made frequent use of the phrase, "illegal
mass medication." The use of the phrase implies that all mass medication is
illegal, but that is not correct because it is, of course, legal to require all citizens
to be vaccinated against smallpox.
Perhaps the proponents of H. R. 2341 mean that some forms of mass medica-
tion, such as vaccination, are legal, but that fluoridation of the water supply is
not. Even this conclusion is incorrect, since States and cities have the right and
duty to safeguard the people's health. Any steps they may take to do so are
lawful provided they are not clearly arbitrary or irrational.
When the American Medical Association and the American Dental Association,
as well as recognized local professional groups and research organizations,
unanimously state the fluoridation is useful in preventing dental decay, that no
harm is to be expected from employing it, and supply evidence in support of their
opinions no community can be accused of being arbitrary or irrational if they
approve fluoridation of their water supply.
I firmly believe that the Federal Government should not interfere with State
or local action in this matter, and for that reason, I am opposed to the passage
of H. R. 2341.
With kindest personal regards,
Sincerely yours,
Richard W. Hoffman, M. C.
Mr. Pelly. Dr. Knutson, would you tell how the charts were ad-
justed on account of sex, age, and race? Those various charts that
were shown ?
Dr. Knutsox. For the deaths ?
Mr. Pelly. Yes, the mortality rate.
Dr. Knutson. That is done, Mr. Congressman, in order to take
care of the differences in the ages of people in different communities.
So when we say age-adjusted, that means that the calculations of the
death rates are based on the given age categories of the individuals in
the communities. In one community you may have a relatively young
population; in another a relatively old population. If you did not
adjust for age, you would come out with an incorrect conclusion.
Mr. Pelly. How about race, and also sex.
Dr. Knutson. Yes, those are also adjusted for, because there are
differences.
Mr. Pelly. Women live normally longer than men ?
Dr. Knuuson. Yes.
Mr. Pelly. It must have been quite an adjustment.
Dr. Knutson. Yes, it is. It is a routine procedure in vital statistics
to adjust for those factors.
Mr. Pelly. Doctor, would you state for the record the date when
the policy of the Public Health Service was first decided upon to
promote fluoridation on the local level ?
388 FLUORIDATION OF WATER
Dr. Knutson. Yes, sir; I shall be glad to. In April 1951.
Mr. Pelly. Not before that did the Public Health Service, then,
encourage local communities to fluoridate their water ?
Dr. Knutson. No, sir. The study in Grand Rapids was started in
1945, in cooperation with the Michigan State Health Department, the
University of Michigan, and the local health department; but that
was on a study pilot-program basis.
Mr. Pelly. In other words, you participated in a study, but you did
not promote it ?
Dr. Knutson. That is correct, sir.
Mr. Pelly. I notice that some of the studies referred to were not
completed until 1953. In other words, as to the 10-year study that was
explained to us, at that time, then, in 1951, when you began the policy,
you had not the benefit of the 10-year study ?
Dr. Knutson. That is correct, sir. But we did have the cross-sec-
tional data collected in 1943 ; the first observations made in Bartlett
and Cameron were made in 1943 and available for analysis, and they
were analyzed. And, as Dr. Leone indicated, at that time in this com-
munity of Bartlett, where they have eight times the amount of fluoride
naturally that we are considering here, there was no evidence of any
deleterious effects. But the study continued on a followup basis for
10 years.
Mr. Pelly. I want to confess I have always been a little suspicious
of departments of the Government gaining by policy what they can't
by law. I am not specifically referring to this program, but in general
1 am a little suspicious, and I was wondering how you arrive at a
policy. Who decides that suddenly you are going to promote a pro-
gram which you consider in the interests of the health of the American
people, and how is that policy arrived at in the Department ? ^
Dr. Knutson. There are many factors taken into consideration, Mr.
Congressman, in order to determine a policy of this nature. It in-
volves getting the opinions and the knowledge of a vast number of
people who have studied this matter, in order to arrive at that decision.
We, for instance, are assisted by the advice and recommendation of
the State and Territorial dental directors, who are employees of the
State health departments. We are guided by the experts who are on
the council of dental health and the council on dental therapeutics
of the American Dental Association. So that the policy was arrived
at after a thorough scrutiny of the opinions and judgments of these
experts in the field,
Mr. Pelly. When did the American Dental Association, for ex-
ample, adopt a policy in favor of fluoridation ?
Dr. Knutson. Officially, as I recall, in the fall of 1950.
Mr. Pelly. In other words, you considered their position.
Dr. Knutson. Ours came in April of 1951.
Mr. Pelly. They were ahead of you, then.
Dr. Knutson. That is correct.
Mr. Pelly. In the Department itself, though, is that a matter of
your decision, or of the Surgeon General, or who makes the final
determination?
Dr. Knutson. A number of the people ; Dr. Dean, for instance, now
retired from the Public Health Service, was very active in this field
of fluoridation ; Dr. Zipkin here ; Dr. McClure ; and Dr. Arnold. We
FLUORIDATION OF WATER 389
have had a series of people in the Public Health Service who have
been working for, we will say, from 5 to 25 years on this subject.
We also have available the advice and suggestions, recommendations,
and judgment of the friends of those people, the acquaintances, and
also the professional associates in universities and other places.
Mr. Pelly. I was thinking: If some person got into a high office
in your Department and had a lot of friends who were advocating
something that might be wrong, and he was a zealot on that subject,
could he put that program into effect and make it policy in the De-
partment without some consideration by other people? In other
words, what I am trying to get from you is : Do you sit down at a con-
ference table and formally adopt a policy ?
Dr. Knutson. Yes, sir. Yes, there is a conference among these
people with competence in the held, people who have worked in the
iield, who have demonstrated their ability and competence in the field
from a research standpoint; on the medical side, from the standpoint
of biochemistry; and otherw^ise.
Mr. Pelly. Did the State health officials and the advisory council
approve of the general program in this case ?
Dr. Knutson. Yes, sir. Some States were ahead. I believe the
first in the country was Wisconsin. Because back in 1945, the State
health authorities in Wisconsin had already sponsored a program of
fluoridation in the State of Wisconsin.
Mr. Pelly. I was thinking there was a health council which meets
here in Washington to advise the Surgeon General occasionally, and
whether this council might have passed on a program such as this.
Dr. KxuTSOX. Yes. There is an Advisory Dental Research Council
which advises the Surgeon General. It was among the groups which
considered this matter.
Mr. Pelly. And this council considered it prior to April 1951, when
it became the official policy of the Department; is that correct?
Dr. Knutson. That is correct. In other words, it is not a 1-man
decision, or a 2-man decision. There are a wide number of individ-
uals' judgments that are brought into this decision.
Mr. Pelly. Now, I would like to, in layman's language, refer back
to one of the statements made by a witness this morning that I
thought I understood, as meaning that fluoride encourages the deposit
of calcium. Is that correct ? In the bone structure ?
Dr. Knutson. I believe that is correct. Dr. Leone, who is a phy-
sician in this field, though, should answer that.
Dr. Leone. Generally speaking, that is so. We know that fluoride
has an affinity for calcium, and calcium, of course, is deposited in the
bone.
I say fluoride has an affinity for calcium, and calcium is automati-
cally deposited in the bone, in the normal metabolism of the bone.
And in the case of the high fluoride areas, perhaps a little more than
normal is deposited, as I indicated.
Dr. ZiPKiN. I w^ould like to perhaps supplement that answer from
some data available in the literature, which states that in children who
have lived on four parts per million of fluorine in the water there is
no deviation in tlie calcium and phosphorus retention in these chil-
dren.
390 FLUORIDATION OF WATER
If the bones are analyzed for calcium or phosphorus or the excreta
are analyzed for calcium or for phosphorus, there doesn't seem to
be any difference in that retention in kids living in a four-parts-per-
million area.
In other wards, they will eliminate calcium in urine and feces like
persons not living in such an area.
Mr. Pelly. I am interested in the adults, and I notice that a certain
number of people now seem to get discs in their spine or tennis elbows
or bursitis. Would that be due to calcium deposits, and could an
extra amount be induced by too much fluoride ?
Dr. Leone. Our studies do not show any association with that sort
of finding.
Mr. Pelly. Then going on to one of the other questions in my mind,
and then I will let someone else ask questions. I am wondering
whether studies have been made as to the ratio of stillborn cattle in
areas which have an excess of fluoride in the water.
Dr. Leone, I do have secondhand information on that, and the
answer is : Definitely, no. In fact, a group in Tennessee that is run-
ning a large experiment has found that their animals on high fluorides
are more fertile than those on low fluorides; I mean comparatively
speaking.
Mr. Pelly. I think we had some statistics given us this moi-ning
that cattle were more subject to the toxicity of fluorides than humans.
Would the one-millionth of one part of fluoride in water compare
with the figure that was given us this morning for the toxicity danger
point of cattle? In other words, if cattle drank water, Washington,
D. C, water, would it be more fluoride than cattle should drink, in
your opinion ?
Dr. Leone. Let me ansAver it in an indirect manner that I looked
at a great number of cattle in the vicinity of Bartlett, and I never
found any mottling or any evidence of fluoride effect. And I believe
Dr. Zipkin can answer further in terms of actual experimental work
on the ratio of fluoride effect in animals versus the human.
Dr. Zipkin. Dr. Mitchell, at the University of Illinois, has done
extensive work on fluoride metabolism, particularly in farm animals.
And he makes the statement that a toxic level for most farm animals
as a rough estimate is about 100 parts per million.
That is, cows, swine, other farm animals, will tolerate up to that
without any deleterious effects, such as going off feed, refusing to
drink water, or other changes. Some species will vary from that.
Eabbits will take a little more and chickens a little more before they
show toxic changes.
Mr. Pelly. It was about 65 parts per million, as I recall, for cattle.
Dr. Knutson. As I understood that statement, it referred to a com-
parison of cattle with other animals, and not to humans. They are
less sensitive than humans, far less sensitive than humans. But in
relation to other animals, they are more sensitive.
Mr. Pelly. I think 3^011 have answered my question, because as I
understood that statement, it was that cattle were much more sensi-
tive to the effects of fluoride than humans. You are telling me, are
you not, that they are not as sensitive ?
Dr. Knutson. That is correct.
FLUORIDATION OF WATER • 391
Mr. Pelly. I misunderstood the statement given before, then.
Thank you, Mr. Chairman.
Mr. Hale. Mr. Priest?
Mr. Priest. Dr. Knutson, in representing the Public Health Serv-
ice, you oppose this bill that would prohibit local communities from
fluoridation of water i
Dr. Kndtson. Yes, sir.
Mr. Priest. My one question at this point is : Suppose the bill re-
quired fluoridation of local water supplies; would you also oppose it?
Dr. KxuTsox. Yes, I think we would. We have found over many
years of experience that compulsion by law is not a successful measure
nisofar as bringing about eft'ective utilization of a public health pro-
cedure is concerned. "We are in favor of voluntary determination on
the part of connnunities, either for or against.
Mr, Priest. One further question, Mr. Chairman, of Dr. Leone.
Doctor, you referred to an experiment with cattle in Tennessee,
which, of course, is my home State. Do you know whether that
experiment is in Giles County or in the vicinity of Giles County,
Pulaski, Tenn. ?
Dr. Leoxe. I wouldn't know sir. I have it only by word of mouth
from some of the people interested in this work with whom we
exchange information.
Mr. Priest. I presume you know that throughout that ])articular
area of the State there is a rather large quantity of fluoride in the
water in natural solution. That, incidentally, is the area of the great
IMilky Way Farm, that has been at times rather nationally known.
I am not acquainted with this particular experiment.
I wondered if you know it was in that particular area.
Dr. Leone. I am not certain of the exact locality.
Mr. Priest. I shall obtain information from my own State health
commissioner on that.
That is all, Mr. Chairman.
Mr, Hale. Mr. Crosser ?
Mr. Grosser. Doctor, what is your attitude in regard to chlorine?
Dr. Knutsox. Certainly it has been adequately demonstrated, or
fully demonstrated, that chlorine, in its use in the purification of
water supplies, has been a very effective ])rocedure in reducing the
death from im])ure water, such as typhoid fever, the choleras, and so
on. Its usefulness, I tliink, has been demonstrated beyond a doubt.
Mr. Grosser. You make no comparison between these two.
Dr. Knutson. They are similar in some respects, dissimilar in
others. They are both very effective health measures, we think.
Mr. Grosser. You approve of both of them ?
Dr. Knutson. Yes, sir.
Mr. Grosser. We have had chlorine in the water for many, many
years in Cleveland. I know that.
Mr. Heselton. Dr. Knutson, I notice that neither you nor your
associates seem to have filed in your statements any biography, any
background material. It would seem to me that in terms of the record
it might be Avell if you ]>re]^ared a brief statement for submission.
Dr. Kxri'soN. We shall be glad to submit such a statement.
(Information requested is as follows :)
392 ' FLUORIDATION OF WATER
Biography
john william knutsom
(iradnated. University of Minnesota School of Dentistry, with ditctor of dental
suruery degree in 1931 ; dental intern and dental clinician, United States Public
Health Service hospitals, 1931-35 ; child hygiene studies, dental, 1936-38 ; gradu-
ate studies in public health, Johns Hopkins School of Public Health. 1938-40. de-
grees of master of public health and doctor of public health ; dental research and
field studies in cooperation with Minnesota Department of Health and Dental Re-
search Laboratory, University of Minnesota. 1940-44; Chief, Dental Health
Section. States Relations Division, United States Public Health Service. 1944- !S;
Assistant Surgeon General, Chief Dental Officer, United States Pulilic Health
Service. 1952 to date; elected to Omicron Kappa Upsilon, honorary scholastic
dental fraternity, June 1931 ; elected to Delta Omega, honorary scholastic public-
health fraternity. May 1939; recipient of University of Minnesota Outstanding
Achievement Medal Award. February 19!il.
IZADOHE ZIPKIN
Graduated, University of Rochester, major in chemistry, luu-lielor of arts
degree. 1937; graduated. Pennsvlvania State T'niversity, major in biochemistry,
minor in organic chemistry, 19^0; graduated, Pennsylvania State University,
major in biochemistry, minor in organic chemistry. 1942; United States Artoy,
first lieutenant to capitan. Sanitary Corps, 1942-46; biochemist at National
Institute of Dental Research, United States Public Health Service, 194G to
present; elected to Phi Lambda Upsilon. national <hemi<-al honorary fraternity :
elected to Sigma Xi, national research honorary fraternity.
XICIIOLAS CIIAKr.KS I.EONE
Graduated, University of California College of Pharmacy, graduate in
pharmacy degree, 1929 : graduate studies in nutrition and bacteriology. Uni-
versity of California, 1934-36; graduated. Harvard University School of Public
Health, certificate in public health and master of public health degrees, 1941 ;
graduated. Army INIedical School of Tropical IMedicine and Nutrition, 1943 ;
graduated, Yale University School of Public Health, Army School Center, 1944 ;
graduated, Duke University School of Medicine, bachelor of science in medicine
and doctor of medicine degrees, 1950 ; practicing pharmacist. Alliany Pharmacy,
Albany, Calif, (while attending University of California, postgraduate), 1929-
34; inspector, P>nreau of Food and Drug Inspection, California State Depart-
ment of Public Health, 1936-41 ; inspector, United States Food and Drug Ad-
ministration, 1941-42; nutrition officer, Office of Surgeon General, United States
Army, Walter Reed Hospital, 1942-43; nutrition officer. Fort McClellan, Ala.,
1943-44; staff nutrition consultant, ETC, 1944-47; staff nutrition consultant,
ETO and student. Duke INIedical School, 1947-48; staff nutrition consultant.
United States Army, 1948-50; Outpatient Clinic, United States Public Health
Service, Internal Medicine, Washington, D. C, IMarch 30, 1950, to July 1, 1950 ;
Intern, United States Marine Hospital, Baltimore, ]\Id.. 1950-51: Outpatient
Clinic, Internal Medicine, Washington, D. C, July 1, 1951, to August 10. 1951;
National Microbiological Institute (Laboratory Biology Control), Hepatitis (hu-
man volunteer study), Bethesda, Md., 1951-53 ; Chief, Medical Investigations, Na-
tional Institute of Dental Research, National Institutes of Health, United States
Public Health Service, March 1, 1953, to present; Fellow, British Royal So-
ciety of iMedicine, metabolic section ; Bronze Star Medal — Supreme Headquarters.
ETO, 1944 (for work in developing special nutrition survey methods for liberated
and occupied coxmtries of Europe and organizing and directing nutrition sur-
vey team's in Europe 1943-44) ; Ordre Saute Publique (French Minister of
Health), French public-health medal for public-health liaison with the Allied
Forces in France and for conducting nutrition survey on liberation of Paris
and other areas of France, 1944-46.
Mr. Heselton. I have heard, and I believe it is in the record of
this hearing, that fluoride can be made from scrap aluminum;
sodium fluoride.
Have you any comment on that ?
i
FLUORIDATION OF WATER 393
Dr. KxuTSON. I should say or admit that J have heard that fre-
quently myself, Mr. Heselton, but it is not. The majority of fluoride
used in water fluoridation, the great majority of it, is a byproduct of
the fertilizer industry, and it is purchased from the usual chemical
companies; as was indicated this morning, the fluoride from the
Grand Rapids water fluoridation project comes from a firm in Illinois.
But there is a misunderstanding about the source of fluoride com-
pounds. The great majority are byproducts of the fertilizer industry
and have no connection whatever with the aluminum industry.
Mr. Heselton. Is that a particular type of fertilizer, or generally
any type of fertilizer?
Dr. Knutson. Fertilizer made from the phosphate rocks.
Mr. Heselton. I have had a chance now to look at what are termed
figure 1 and figure 2, in connection with food, and I was amazed at some
of the data there.
In the first place, what do the little check marks opposite turnips,
carrots, white and sweet potatoes, mean ?
Dr. ZiPKiN. That is a mathematical symbol meaning "less than,"
Mr. Heselton. I am amazed to notice that milk chocolate ranges
from 0.5 to 2 fluorine parts per million. Is that the edible chocolate, or
is it the chocolate included in chocolate milks ?
Dr. ZiPKiN. It is a milk chocolate, I presume a manufactured item.
Mr. Heselton. That is, the chocolate bar ?
Dr. ZiPKiN. I presume so, yes.
Mr. Heselton. And then I notice that in connection with tea, it
ranges from 30 to 60 fluorine parts per million, which, as I understand
it, is a very heavy concentration of fluoride.
Dr. ZiPKiN. Yes. Thirty to sixty parts per million is an elevated
figure.
Mr. Heselton. What is the reason for the variation ?
Dr. ZiPKiN. Well, there could be a number, I suppose, possibly
where they were grown; possibly because the soil had a higher con-
centration of fluoride in one case than another. Perhaps it is present
where the substrata of water which is rich in fluoride runs past vol-
canic regions. In Italy, around Vesuvius, for example, there is a high
concentration. There are a number of contributing factors.
Dr. Knutson. I think it should be said that these are the concen-
trations in the tea leaves. As for a cup of tea, which is a brew of the
tea leaves, if you drank a cup of tea you would get about two-tenths of
a milligram.
Mr. Heselton. Then I noticed that round steak is 1.3, and frank-
furter is 1.7. Is there any particular reason for that, that you knnw
of or advisable to determine ?
Dr. ZiPKiN. "Why round steak should differ from hamburg ?
Mr. Heselton. Yes.
Dr. ZiPKiN. I don't feel there is a real difference between 1.7 and
1.3. I don't know why there should be a differenre between the two.
This represents the fluorine content as the food is consumed; I sup-
pose it is available to the consumer. And it would not contribute a
great amount of fluoride to the entire consumption, daily consumption.
That is, theoretically, if you ate only this, you would have to eat two
pounds of it at a sitting or something of that sort.
394 FLUORIDATION OF WATER
Mr. Heselton. Then further, I notice that canned fish seems to
liave rather a marked concentration, raiiaino" from 4.40 to 1^.50.
Is there anytliino; about the process of canninf^ tliat accounts for that?
Dr. ZiPKiN. Possibly, yes. These are probably done under sealed
conditions. I am not familiar witli the mechanical processes of can-
ning, but there evidently is a concentration of the fluoride in the
process of canning, I presume, since, as you mention, the fresh fish
is less.
Mr. Heselton. Dr. Leone, referring to the third page of your state-
ment, I notice in the second finding you dismiss the liigher incidence
of cardiovascular disease in Cameron as "an observation unrelated to
fluoride to ingestion." How did you determine that ?
Dr. Leone. Simply that Cameron is the control city, with just a
trace of fluorine in the water.
We were studying it against Bartlett, which was the city of con-
cern.
Mr. Heselton. And then in the fifth finding, referring to the only
diflerence in frequency rates as being in the counts of white blood cells,
tending to be higher in Bartlett, you then said :
This difference, when viewed in light of clinical circumstances, does not sug-
gest an association with fluoride intake.
Standing alone, I didn't quite understand tliat. What were the
clinical circumstances?
Dr. Leone. The circumstances are that white cells normally vary
in the blood stream. Tliat is, your white cell count may vai-y from hour
to hour, or if you have a cold your white blood count will be up. If,
for instance, the survey was done in the summertime in one area, and
perhaps a few days later, when we had a cold spell and everyone had
the sniffles, it is very likely that the white count would be up. But it
is something that varies.
Mr. Heselton. Dr. Knutson, you were questioned on one phase of
this matter before, and I would like to go a little further. I am inter-
ested in your statement that "there is no justification for any Federal
intervention in local health matters." I certainly subscribe to that.
I would like to know a little about the way in which the Public Health
Service operates. Has the Public Health Service ever initiated an
effort to place fluoride into a local water supply ?
Dr. Knutson. I hesitate, because — initiated at our instance, no.
Mr. Heselton. Did they write to them or send to them or in any
fashion initiate it ?
Dr. Knutson. No, sir, I can assure you that your State health offi-
cials are doing a good job of protecting their communities from our
doing anything such as that, nor would we have any desire to do so.
We enter a State only when we are invited or asked by the State
officials to come to confer with them on technical matters or give them
advice.
Mr. Heselton. Then, taking a concrete case, if the State officials
ask you to confer with them and fm^nish them with technical assist-
ance or anything in the way of advice, you comply with that request,
I take it?
Dr. Knutson. Yes, sir. To the best of our ability.
Mr. Heselton. Do the local communities address those, either di-
rectly through you or through the State health authorities ?
FLUORIDATION OF WATER 395
Dr. Knutson. Occasionally we do get the request from the local
comimuiity, but in each of those cases we refer them to the State
health department, so that we do not supply technical assistance with-
out it being requested l)y and through the State health dej)artment.
Mr. Heseltox. So that the State heaUh departments are in fact in
CQutrol of the question of whether a community Avater supply shall
be fluorinated. if that is the word; that is, subject to, of course, what-
ever they do in terms of their own communities?
Dr. Knutsox. Yes, sir. I think that is true. I think their policy
is like ours, though. They do not and would not wish to impose
fluoridation on a community. They would like to have that deter-
mination made by the community. Nevertheless, virtually every State
healtli department now reconnnends fluoridation as a standard
])rocedure.
Mr. Heseltox. That is an expression that I wanted to ask about.
You sa}^ ''virtually." How many do ?
Dr. KxuTsox*. I believe the count is 46 or 47, plus the Territories.
I can get that information for you, currently. And the one or two
States that have not yet ajjproved it are in the southwestern section,
where virtually all connnunities have either the optinuun or too nnich
fluorine in the water supply.
Mr. Heseltox'^. Incidentally, I noticed in the map you furnished
that only a few States apparently have no natural fluorine.
jNIv own State of Massachusetts apparent has none, and the chair-
man's State of Maine. I believe in Vermont and Rhode Island, in
New England, that is true, and perhaps one or two other States in
the rest of the country. Is there any way to account for that?
Dr. KxuTsox. The presence of fluorine in a drinking water supply
depends to a great extent or almost entirely on its source. If the
water comes from ground waters, and that ground water flows over
rocks that contain fluorides, then there will be fluoride in the water
supply. If not, they will be fluoride-free. As you indicated and ob-
served, the number of communities with natural fluoride in the water
supply in the New England States is very small in number. Also, as
you perhaps know, the highest dental caries rates in the country are
observed up in the New England area.
Mr. Heseltox*. You say thev are the highest in the countrv up
there ?
Dr. KxuTsox*. Yes, sir.
Mr. Heseltox. I didn't know that.
How many people are engaged in this activity in the Public Health
Service ?
Mr. Hale. You mean in fluoridation ?
Mr. Heseltox. Experts are dealing with the problem of fluorida-
tion— seems to be the word — of water supplies.
Dr. KxuTSOX". I would say in answer to that question that no one
individual is engaged full time in this matter or subject alone. They
have a diversity of assignments. For instance, the two men with me
are research people, who have done some research in the area of
fluorides but are doing other research as well.
Now, they are asked for or receive letters asking them for advice
on fluoridation and for their technical knowledge. One can say that
they are assisting in promoting fluoridation, by supplying accurate
48.*591— 54 26
396 FLUORIDATION OF WATER
scientific evidence. But for the record, I can say that we have made
an effort on the basis of other requests to determine how much funds
we are expending in promoting fluoridation that can be, say, cut out
from the time that individuals might spend on it, and our estimate
runs somewhere between forty and fifty thousand dollars. Any of
our consultants in the field, in the regional offices, the Surgeon General
included, are asked from time to time for advice and suggestions about
fluoridation. We receive letters asking for technical information,
that may include not only the fluoridation problem but other prob-
lems. So I want to make the point clear that it is ratlier difficult to
measure beyond that broad term.
Mr. Heselton. That is your best estimate as to the current expendi-
tures ?
Dr. Knutson. That is correct.
Mr. HESELTOi«f. And have they increased or decreased or stayed at
the same level for a number of years ?
Dr. Knutson. I believe that we could say that it has decreased
during the past year. In other words, as the States increase their
expertness in the field and their own technical knowledge, then the
need for our assisting and guiding decreases.
Mr. Heselton. Now let me ask you this : Do you have anything in
the nature of what would be called a kit that could be sent, after clear-
ance with the State health authorities, to local communities, contain-
ing descriptive literature, or articles, or directions, or anything of that
nature ?
Dr. Knutson. Yes, sir. We do have a collection of material that
is gotten together specifically for the purpose of supplying individuals
with information they request of us. But the dissemination of those
kits of information is largely the responsibility of the State health
departments. The American Dental Association has such a kit. We
have, if I recall correctly, only 2 pieces of literature in that kit,
which may amount to 10 or 15 different articles, or pieces of literature,
defining the mechanical procedures involved in fluoridation, the bene-
fits, and so on. We have, I believe I am correct in saying, only two of
those pieces that were prepared by us.
Mr. Heselton. Will you furnish the committee with a sample of
that type of kit ?
Dr. Knutson. Yes, sir ; I shall be glad to.
Mr. Heselton. Is there a representative of the American Dental
Association still here ?
Would you furnish the committee with a sample of tlie kit the
American Dental Association has in connection with fluorine?
Dr. DoTT (J. Roy Doty, American Dental Association). T would
be very happy to, sir. A year ago, we sent each Member of Congress
a copy of that kit, and just recently we wrote the Members a letter
asking of they would like another one, and we have received so far
letters from Congressmen stating they had it and some letters stating
they had misplaced them, and requested another.
We will send that out to you.
Mr. Pelly. Just to clear the record, I was under the impression
that some witness testified that there were teams from the Public
Health Service that go around to propagate propaganda. And you
deny that, I take it ?
FLUORIDATION OF WATER 397
Dr. KxuTSON. I am not aware of such teams being in existence, sir.
Mr. Pelly. I have seen a record somewhere of a meeting held in the
Public Health Service, of notes taken down of discussions that were
had in a so-called sales meeting, where so-called euphemistic terms
were given out to be used in "selling the program," for example, "Never
use the word 'artificial' fluoridation," that would indicate to me that
certainly there was a sales meeting going on for the purpose of dis-
seminating or spreading a program.
Do you know what I refer to ?
Dr.'KxuTSox. Yes, indeed, I do. Every 2 3'ears there is a meeting
held in Washington of the State dental directors. These are eni-
ployees of the State health departments. They have asked for this
meeting. They want this meeting so that they can get together and
exchange information, exchange experiences, so that they may be, let's
say, well informed on what is going on in a modern dental public health
program. I can assure you tTiat the discussions at those meetings are
not in any way under our control. These individuals are quite able to
take care of their own opinions and express their ideas very well, and
there is, I would say, full freedom for each individual State dental
director to express his own opinions and ideas on fluoridation or any
other ])hase of a dental health program.
Mr. Pelly. When the issue of fluoridation comes np on the local
level in some community, and the matter is to be referred to the people
for a vote, then I take it that no team comes in to sell or propagandize
the program.
Dr. Knutson. No, sir; not so far as the Federal Government is con-
cerned.
Mr. Heselton. There was a gentleman here either yesterday or the
day before from Worcester, Mass. As I recall he had a pamphlet
which he described as containing things to say and things not to say.
I didn't see the pamphlet itself. I recall asking him if I was correct
in my understanding that it w^as printed at the city hall. I think he
said "yes," but he believed it came from some other source. Have you
seen any such pamphlet ?
Dr. Knutsox. Of things to say and things not to say ?
Mr. Heseltox. Yes ; that is what I understood him to say.
Dr. KxuTsox. Yes. I have seen from time to time suggestions from
those who are competent in the field of health education on, let's say,
the best methods of presenting matters relating to health, not only in
fluoridation but other matters.
Mr. Heseltox. I am confining myself to fluoridation.
Dr. KxuTSox. Yes. I have seen such presentations, which w^ill in-
dicate or suggest that one use certain methods of discussing the matter
when discussing it on the local level.
INIr. Heseltox. Is that anything that has been prepared in the De-
partment, or by the Department's recommendation ?
Dr. Kx^TJTSOx. There has been no such leaflet prepared by the Fed-
eral Government, the Public Health Service, in particular.
Mr. PIeseltox. Do you happen to know who did prepare it ?
Dr. KxFTSox. I think reference was made yesterday to a pamphlet
prepared by Dr. Phair, of the American Dental Association, in which
he made some suggestions as to procedures which might be efi'ectively
employed in promoting fluoridation.
398 FLUORIDATION OF WATER
Mr. Pp:lly. I might say that I think it was hist year that I sent over
to the Department and got the minntes of a meeting which I believe
had been held in the Department covering the subject of language
that might best be utilized in discussing fluoridation on the local
level, and I think possibly those same minutes of that meeting were
utilized, on the local level, and might be the ones that were referred
to.
Dr. Knutson. Any suggestions at that meeting relating to the sub-
ject were discussed by State dental directors who were participants
in the meeting.
Mr. Pelly. I think that is the one that my colleague is probably
referring to.
Dr. Knutson. Incidentally, that material is not for public distribu-
tion. It was a verbatim copy of minutes of the meeting, and the
Public Health Service, the Surgeon General specifically, is not author-
ized to disseminate minutes of meetings unless so authorized by the
participants. And we never were authorized by the State dental
directors to disseminate those verbatim minutes. They were for their
technical information only.
Mr. Wakburton. Doctor, I am sorry I was not here earlier, be-
cause I wanted to hear all of your testimony and also the testimony
of your two associates. The possibility may exist that you have an-
swered these questions I am going to ask you. However, there are still
a couple of points that are shadowed in my mind. The first one is
this : As I recall the testimony from yesterday morning's meeting, it
was indicated that there is an honest division of opinion within the
medical and dental professions with regard to the efficacy of this
treatment of water to attain the end for which it is designed. Is
that correct ? That is a recollection on my part.
Dr. Knutson. That is correct, but I think it should be qualified.
The American Dental Association, for instance, is the official organi-
zation representing about, I think, close to 80,000 of the dentists in
this country. The total is maybe 88,000. Let's say they represent
about 80,000 of the dentists. They have endorsed water fluoridation.
And the great majority of dentists in this country are of the opinion
that this is the best, most remarkable preventive that has ever come
on the horizon of preventive dentistry. That is the great majority.
There are exceptions. So that is why I say this professional ditfer-
ence should be qualified.
That is also true within the medical profession. The American
Public Health Association, which is largely medical, or at least its
l)rincipal constituents are medical people, has endorsed this proce-
dure. Virtually every national health organization concerned with
health has endorsed this procedure; the National Research Council,
the American Academy of Pediatrics, that is, physicians who treat
children. Virtually all of them have endorsed it.
Now, there are exceptions. There are individual dentists who dis-
agree. There are individual physicians who still are opposed to small-
pox vaccination.
Mr. Warburton. Let me ask you this: What is the method, if you
are familiar with it, by which the various dentists and medical men for
whom these various associations speak receive their basic knowledge
as to this particular o])eration, prior to the time that the particular
FLUORIDATION OF WATER 399
association speaks for tlieiu by resolution recommending adoption of
the process ?
Dr. Knutson. By and large their procedure is much the same as I
outlined that we go through in the Public Health Service. AAHien they
have a matter of this import to consider, they appoint a committee, a
study committee, and appointed to that committee are men who have
demonstrated either their competence in the field of fluoride research
or in other research, or their ability to evaluate research ; so that they
can evaluate this material — as I indicated, about 7,000 books, pam-
phlets, and articles — on fluorides and tlieir effects on humans and on
animals.
They appoint a connnittee, whose individuals have demonstrated
their ability to evaluate this material, this scientific evidence, and to
come forth with a solid recommendation. They must do that in order
to protect the integrity of their organization.
Mr. Warburton. Now, in an area like this, Avhere, as I understand
this whole situation, we are attempting in effect to apply a general
overall form of preventive medication, shouldn't there be almost com-
plete unanimity as to the efficacy of that project, even as between in-
dividuals, trained individuals, wlio operate in the same fields of exami-
nation to determine the efficacy of it? In other words, how can two
reputable practitioners or experimenters or whatever you call them,
upon the same subject of the effect of fluoride ingestion into the human
body, come up with completely diversified results or conclusions as to
what that effect is ?
Dr. Knutson. I would say on that ])oint that there has been an
amazing uniformity of findings among those who have worked for as
long as 30 years in this field.
Mr. Warburton. Well, I find a discrepancy still exists in my mind,
for example, as between some of the medical testimony on this par-
ticular point that has been given by the proponents of the process, as
compared to some of the testimony that has been given by apparently
equally qualified medical men who oppose it.
Apparently the particular witnesses on each side are equally well
trained and equally reputable, and yet on the same subject they come
out with widely diversified results. Now, I am not a doctor, as you
know, or chemist, but it seems a rather unique situation to me.
Dr. Knutson. I think one might account for that on the basis that
individual physicians, idividual dentists, vary remarkably in their
ability to evaluate scientific information.
Mr. Warburton. Then in the case of a dentist who writes to me from
the State of Delaware and asks me to support the public health posi-
tion, having ])ermitted, through the connnittee and convention process,
the American Dental Association to speak for him, am I to assmne that
he knows or does not know what he is talking about from his own
practical experience ?
Dr. Knutson. I would not advise you to assume it, sir. I think
there are ways of checking information. We are confronted with
that same problem quite frequently. And there are ways of checking
on, let's say, the validity of the claim ; of holding back on a recommen-
dation until it lias been tested and reconfirmed by competent investi-
gators. I illustrated the findings from Grand Rapids here. In inde-
pendent studies from Newburgh, N. Y., studies which we had nothing
400 FLITORIDATTO^T^ OF WATFR
to do with, and Bradford, Ontario, and Evanston, 111., eacli of them in-
dependent studies, the results are remarkably the same as ours.
Mr. Warburton". And you have faith obviously in the results of
those studies ?
Dr. KxuTSON. That is correct.
Mr. Warburton". Then let me ask you this : T^Tiy can't you con-
vince these other people in your same profession ?
Dr. Knutson. The history of the opposition to fluoridation is con-
siderably like that noted in the opposition to chlorination of water
supplies. I don't think there is any question but what perhaps 99.9
percent of the physicians in this country heartily endorse chlorination.
It is no longer a controversial issue. But there are a few physicians
yet who oppose chlorination. The same is true of vaccination. We
never reach universal agreement. And we have not in fluoridation,
and I don't expect 20 years from now we will have reached full
agreement. Because individuals, again, vary in the amount of evi-
dence they require before they adopt something.
Mr. Warburton. Let me say this to you, Doctor : I am not trying
to be facetious, and neither am I trying to harass you in this line of
questioning. However, there seems to me, from what I have been
able to gather from the hearings, here, and from conversations in my
own district, and from letters I have received, a relatively wide
divergence of opinion as to the efficacy of this program. It seems
to me that when you are in a situation where you are advocating
what is, in effect, universal preventive medicine, which the individual
himself cannot avoid, unless he wants to, for example, stop drinking
from his usual water supply, you should have an area of almost
complete unanimity, recognizing that you also have that element in
any profession that won't accept what the great bulk believe is the
correct conclusion. But as I understand it, medically this process
which is being advocated is unique within the United States. I don't
know that there is any other preventive medicine area where the whole
scale of population have been, as individuals within the local scale,
subjected to the treatment. And it seems to me that it is the estab-
lishment of a pretty wide precedent which should be fairly solidly
based upon the total support, again barring the human element of
dissidence, of the profession which are primarily concerned with it.
Does that make sense, or does it not ?
Dr. IvNUTSOisr. Yes, indeed, it does. And, Mr. Congressman, I can
assure you that in my opinion and in the opinions of those who have
worked on this problem, we can say with conviction that no other
public health procedure has been so thoroughly investigated ])rior to
recommendation that it be employed as has water fluoridation. We
do not view it as medication. It is more in the area of adding trace
amounts of desirable elements ; such as fortifying bread with vitamin
D or fortifying milk, or iodized salt, or things of that nature.
Mr. Warburton. Isn't that basically the same thing as medication ?
In other words, aren't you adding something for human consumption
whose end-result is to reduce susceptibility to some bodily ailment or
physical defect ?
Dr. Knutson. I believe the medical men inform me that medication
means treating. We aren't treating dental caries here. We are pre-
venting; it.
FLUORIDATIOX OF WATER 401
Mr. Warburton. I appreciate that. Plere what you are doing is
attempting to reduce the body's susceptibility to caries of the teeth.
Dr. Knutson. That is right.
Mr. Warburtox. Now, let me ask you this. Does that stand on
the same basis, for example, from the medical standpoint, as giving
injections of gamma globulin in order to increase the body's resistance
to polio ?
Dr. Knutson. Similar in some respects. Quite dissimilar, though,
I should say, in othei-s
Mr. Warburton. Why is it dissimilar ?
Dr. Knutson. When you go into a grocery store and pick up a pack-
age of iodized salt, I don't think you feel you are medicating your
family or those who use it.
Mr. Warburton. I think that is only because I personallj^ have
accepted it as a fact that it has a beneficial effect, and that is the only
reason. We become accustomed to accepting it.
Dr. Knutson. You see, in essence, as I see this— and I recognize
that everyone won't agi'ee with me — we have demonstrated that fluo-
ride in water supplies is distributed fortuitously by nature. It may
be very low in some water supplies and very high in others.
What we are recommending here is that we not accept that, but
make that water have the optimum amount of fluoride, not too mucli,
not too little, but the optimum amount.
Mr. Warburton. But hj the same token, in those areas where the
water is not naturally in that condition, the Public Health Service
advocates artificial addition.
Dr. Knutson. That is correct.
]Mr. Warburton. And in those areas where the water naturally has
more than what you consider the optimal condition, you would by some
mechanical process subtract down to the optimum ?
Dr. Knutson, That is correct.
Mr. Warburton. The reason for my concern is because I come from
the second smallest State in the Union. I have received a request
from our State dental society to sup2:)ort the Public Health Service's
position with regard to the bill we are now considering. Yet, I liave
also received a substantial number of letters from individual dental
practitioners asking me to oppose it. And I am in the unfortunate
position of having to be able to find out enough about the subject to
make a sensible answer to both sides of an issue like that. It is highly
controversial for me, personally.
Let me ask you one other question on that particular score. Let us
say that the position which the Public Health Service advocates is
that the general public water supply be fluorinated, or fluoridated,
or whatever the correct word is. Then, if for example, gamoglobulin
or something else were specified as being just as efficacious in treating
polio as you believe this is in preventing dental caries, would the
Public Health Service advocate that the local communities by majority
vote subject my child to ingestion of it just prior to the polio season?
Dr. Knutson. You mean on a compulsory basis ?
Mr. Warburton. On a majority vote basis within the communities,
which is my understanding of tlie way you think this should be done
with regard to fluoridation.
402 FLUORIDATION OF WATER
Dr. Knutson. I think that is an individual community determina-
tion, and there are some States where they require, for example,
smallpox vaccination before you can enter public schools.
Mr. Warburto?v'. I appreciate that. That is ordinarly by act of the
legislature.
Dr. Knutson. That the determination shall be on a community
basis and not what Public Health Service wants.
Mr. Warburton. I agree with you on that score. My point is this :
This appears to me, as well as I 'have been able to discover, the first
or original situation where the Public Health Service, and therefore
the Federal Government, in effect, have advocated this type of treat-
ment, or medication, or whatever you want to call it, in order to pre-
vent or to minimize a physical disability of some nature.
Can we take it one step further, and say that the Public Health
Service would, for example, support the local communities' majority
vote — and this is in the municipalities — to have all the children in the
connnunity injected with gamma globulin, in order to minimize the
incidence of polio ?
Dr. Knutson. First, I sliould like to say that it is not the first.
The chlorination of water supplies has been endorsed by the Public
Health Service, and we reconnnend that public water supplies be
chlorinated. The fortification of bread has been recommended.
Mr. Warburton. That was knocked out by the Supreme Court,
wasn't it, though, to a great extent ?
No, I am sorry. I am thinking of something else.
Dr. Knutson. I think not.
You are in an area where it is rather difficult to cross this line of
inoculation with a material that has not been tested anywhere near
as fully as water fluoridation. The one it Avould be comparable to
or most comparable to would be vaccination. And, as I indicated,
they do have compulsion, community-wise, indirectly, by requiring
in some States and some communities, that a child be vaccinated before
entering school.
Mr. Warburton. That is rightt. We have it in Delaware, as a
matter of fact.
Dr. Knutson. I am not, let's say, competent to speak in the area
of the polio vaccine, but when it reaches the stage of having proved
its value as fully as smallpox vaccination, I should not be surprised
but what some communities will do their best to try to see that all
children are protected.
Mr. Warburton. Let me ask you one further question along the
line that ISIr. Pelly and Mr. Heselton were talking just a moment or so
ago.
I understand that the Public Health Service has a movie with regard
to this process ; is that correct ?
Dr. Knutson. Yes, sir.
Mr. Warburton. What is in effect the nature or content of that
movie? I have a special interest. It was made in the town of Newark,
Del.
Dr. Knutson. That is correct.
The movie portrays the procedures through which a connnunit}'
might ordinarily go, or the steps it might take, in bringing about
fluoridation in the community.
FLUORIDATION OF WATER 403
Mr. Warburton. What do vou mean by bringiii<>; about fluorida-
tion?
Dr. Knutsox. Tliis tilni is designed for the use of, let's say, local
health councils or State health people, who are interested in brin«>in<r
about fluoridation in a conununity which has a fluoride-deficient w^ater
supply.
And this presents facts relatin<x to that fluoridation ; wdiat benefits
they can expect; how readily and how easily they can control the ad-
justment of the w^ater supply; what will be the cost of this procedure;
and so on.
]Mr. WARBUitTON. In other words, it f^ives the selling arguments for
fluoridation ?
Dr. Knutson. That is correct.
Mr. Warbtjrton. How does that get into the hands, for example,
of town A in the State of Washington ?
Dr. Knutson. He will get it from his State health department, not
from the Public Health Service.
Mr. Warburton. How does the State health department get it?
Dr. Knutson. They get prints of the film from oar regional offices.
We have a limited number of them, and, as you might imagine, these
prints are not in use full-time, so that with the limited nmnber and
through that distribution system, they are made available whenever
they are requested.
Mr. W^arburton. And they are requested. They have to be re-
quested by the particular State board of health which w^ants to use
them within the State ?
Dr. Knutson. That is correct.
Mr. Warburton. No further questions.
Thank you. Doctor.
Mr. Hale. Thank you very much, gentlemen.
The committee appreciates your contribution, which has been im-
portant.
Maj. Robert W. Hobson.
How long will your statement take. Major Hobson ?
STATEMENT OF MAJ. ROBERT W. HOBSON, DENTAL CORPS, RE-
SEARCH AND DEVELOPMENT DIVISION, OFFICE OF THE SURGEON
GENERAL
Major Hobson. Two to three minutes, sir.
Mr. Hale. You are very welcome.
Major Hobson. Mr. Chairman and members of the committee: I
am Robert W. Hobson, major. Dental Corps, a member of the Research
and Development Division of the office of The Surgeon General, De-
partment of the Army. I represent the Department of Defense in
ex]:)ressing the opposition to the enactment of H. R. 2341.
The principle of fluoridation of certain portable water supplies as
a means of preventing dental caries in children has been accepted by
the American Medical Association, by the house of delegates of the
American Dental Association, by the Food and Nutrition Board of
the National Research Council, by the governing council of the Amer-
ican Public Health Association, by the United States Public Health
Service, and by other Federal and State agencies interested in public
health.
404 FLUORIDATION OF WATER
Irrespective of the views taken by the above agencies, it has been
asserted that fluoridation is still in the experimental stage. The fact
is that fluoridation of public water supplies cannot be considered "ex-
perimental" in the usual sense of the word or that the procedure has
not been adequately studied. Various factors relating to fluoridation
have been under study for at least 25 years.
Controlled studies of the addition of fluorides to water supplies be-
gan in 1945, and have shown almost the same pattern of protection
against dental caries for children born and reared in these commu-
nities as is observed in areas where fluorides occur incidentally to the
water supplies. Continued observations will establish the degree of
effectiveness in older age groups who used fluoridated water during
childhood.
It has further been asserted that artificial fluoridation may not
produce the same results as do natural fluorides. Actually there is no
such thing as "artificial fluoridation." Fluorides are always added to
water, generally being picked up by water running through under-
ground passages and crevices where the ground contains various
fluoride compounds. In this process man has no control over the con-
centration. Studies show that the same results occur whether the
fluoride is added in controlled amounts or whether added happen-
stance by nature, except that desired results are assured when the
fluoride is added in controlled amounts.
As controlled studies on the subject of fluoridated water are con-
tinued, there is increasing evidence that older populations may also
benefit from this practice. If this point is proved, then it will be de-
sirable for the armed services to fluoridate water on posts where the
water is deficient in this chemical.
In order to reaffirm the position of the agencies mentioned in the
first paragraph of this statement and to determine the present posi-
tion of the National Research Council, the Council was asked to re-
state its position on the principles of fluoridation of potable water
supplies in September 1953. The following statement was received
from the National Research Council :
The Committee on Dentistry of the National Research Council believes that
there is sufficient scientific evidence of the merits of fluoridation of public water
supplies to justify its use on military posts whenever feasible, and especially
where there is a child population in residence.
In view of the above positions taken by authoritative bodies, it is
the opinion of the Department of Defense that under controlled con-
ditions the fluoridation of water supplies is a public health asset and
that legislation which would prohibit this practice would be detri-
mental to the public interest. Therefore, the Department of Defense
opposes enactment of H. R. 2341.
Mr. Hale. Thank you. Major Hobson.
Are there anv questions ?
Mr.Pelly?
Mr. Pelly. Major, are any defense appropriations used for research
in the field of fluoridation ?
Major HoBsoisr. None in the field of fluoridation in this sense : There
are some — and I don't know the extent — topical applications of
fluoridation.
Mr. Pellt. Wliat do you mean by that ?
FLUORIDATION" OF WATER 405
Major HoBsoN. Topical application of fluoride is the application
of fluoride to teeth by a dentist or a trained technician.
Mr. Pelly. As far as we know now, according to the testimony that
has been given, fluoride does not benefit teeth beyond the age of 1)
years; is that right?
Major Ilonsox. It is my opinion, from what I have read, that there
is increasing evidence that it might, and in that case we are interested.
Mr. Pelly. Up to now, how far ?
Major HoBSON. We are not fluoridating water on any military post,
camp, or station that I know of. "We are, on some posts, camps, or
stations, receiving fluoridated water that is purchased from local
connnunities.
Mr. Pkllv. In othei- words, you woidd be affected by this legisla-
tion '.
Major HoBSON. Yes, sir.
Mr. Pelly. Thank you,
Mr. Priest. Just one furtlier ([uestion, Mr. Chairman.
So far as you know. Major, is it contemplated that perhaps in the
innnediate or more remote future there might be fluoridation of water
on military ])osts, if a supply is not available locally ?
Major HoBSON. 1 would say I believe all services have had such
re(piests, sir.
Mr. Priest. I believe the recommendation of the National Defense
Council was that it should be done particularly where children were
present on the post.
Major HoBSOx. Yes, sir. That is correct.
Mr! Priest. That is all, Mr. Chairman.
Mr. Hale. Are there other (luestions ?
Thank you very much. Major Hobson.
Major HoBSON. Thank you, sir.
Mr. Hale. Dr. John D. Porterfield, Association of State and Ter-
ritorial Health Officers.
STATEMENT OF JOHN D. PORTERFIELD, M. D., VICE PRESIDENT.
THE ASSOCIATION OF STATE AND TERRITORIAL HEALTH
OFFICERS
Dr. Porterfield. This opportunity to appear before you is nuich
appreciated. I am a physician specializing in public health and have
worked in that specialty for the past 15 years. Since 1047, I have
been director of health for the State of Ohio. Presently, I am vice
president of the Association of State and Territorial Health Officers.
In that capacity I speak to you today as the designated representa-
tive of the 53 health authorities of the States and Territories of the
United States. It is these officers who carry a major responsibility
within the respective States for the maintenance of standards gov-
erning munici])al water supplies. They are also responsible in great
part for dental health programs with particular emphasis on jire-
ventive measures in this field.
The Association of State and Territorial Health Officers has taken
the following actions, by vote of the full membership, approving and
recommending the controlled addition of optimum amounts of fluo-
rides to public water supplies for the partial prevention of dental
caries :
406 FLUORIDATION OF WATER
Association of State and Territorial Healtli Officers, Annual Meet-
ing, 1950 :
Whereas careful scientific observations since 1929 indicate tliat tootli decay
is not as prevalent in individuals using water supplies containing sodium flu-
oride ; and
Whereas the artificial fluoridation of public water supplies was experimentally
instituted and has been under continuous study since 1945 ; and
Whereas these studies have shown that there is no menace to the teeth of
the persons using 1 part per million of sodium fluoride ; and
Whereas State and Territorial dental health directors have endorsed in prin-
ciple the fluoridation of public water supplies as a partial protection against
dental caries : Therefore be it
Resolved, That the Association of State and Territorial Health OflScers recom-
mends, where the medical and dental professions concur and where communi-
ties can meet the standards of the State health authorities that all State health
officials approve the artificial fluoridation of public water supplies for the partial
control of dental caries.
And in its annual meeting of 1051, the following recommendation
was made :
That the State and Territorial health departments be urged to conduct more
intensive promotional and educational programs designed to bring the benefits
of water fluoridation to all communities as soon as possible.
In its annual meeting in 1952, the following recommendation was
made:
That the State and Territorial Health Oflicers Association, in view of the over-
whelming evidence in favor of water fluoridation, reemphasize that the full bene-
fits of this public health measure should be brought to all communities as rapidly
as possible, and that association members aid communities in developing fluori-
dation programs by providing efl'ective information, dental and engineering as-
sistance.
And in its annual meeting in 1953 :
It is recommended that the Department of Health, Education, and Welfare
develop jointly with the State and Territorial health officers and their dental di-
rectors a plan to further expand, emphasize, and distribute information con-
cerning the values of fluoridating water systems deficient in fluoride.
In addition to these formal actions taken by the association, virtually
all individual State health authorities have established procedures for
the approval of community fluoridation plans.
Rather than review the scientific evidence which formed the basis
for these actions, I would like to describe the responsibility of a
State health officer regarding the use of newly developed procedures
for the prevention or control of disease.
A State health officer is charged by law with the protection of the
public health and the prevention and control of disease. Wlien any
procedure is purported to provide health benefits he must carefully
evaluate its effectiveness, safety, and practical worth.
This serious responsibility is one which leads to the development
on the part of a State health officer of an extremely conservative atti-
tude and a very critical point of view with respect to new^ advances in
health practices.
It is within this framework of responsibility that the association
examined the scientific evidence and, recognizing its responsibility,
not only to safeguard the public health, but to promote procedures
designed to improve the health status of our citizens, has seen fit to
endorse and recommend controlled water fluoridation for the preven-
tion of tooth decay. The association took due cognizance of the
FLUORIDATION OF WATER 407
claims that the procedures would be a hazard to health and found
them without basis in scientific fact.
Therefore, the Association of State and Territorial Health Offices
is firmly of the opinion that the passage of H. R. 2341 would not be in
the public interest and, furthermore, its enactment would in fact be
a contradiction of the overwhelming scientific evidence supporting
water fluoridation as a safe and effective preventive of dental caries.
Mr. Hale. Are there any questions of Dr. Porterfield '(
Mr. Beamer ?
Mr. Beamer. Dr. Porterfield, I have received letters from the In-
diana Dental Society, which substantiates the statement you have
made, and I take it all the States have organizations that belong to
your association ?
Dr. Porterfield. No, sir, the Association of State and Territorial
Health Officers is made up exclusively of the State health officer of
each State and Territory.
In each of those States and Territories, there is a dental association.
And much as Dr. Knutson described his use of advisory councils of
experts, so, too. State health officers, in coming to these decisions of
policy, confer with the dental health councils when it is a dental
matter and with other people who have experience or ability in the
field in question.
Mr. Beamer. The reason I make this statement is because I have
received no letters from the Indiana State health officer, although I
have received numerous letters from the dental societies and from in-
dividual dentists. I am wondering whether or not the State health
officer confers with the various dental societies.
Dr. Porterfield. It is my understanding that he does, sir. I am
personally familiar, to some degi"ee, with both the State health officer
and with his methods of operation in that State, and that is his practice.
And I know personally that he has endorsed, as the chief health officer
of Indiana, the fluoridation program.
Mr. Hesi:ltox. Doctor, I notice that beginning in 1951, and follow-
ing it up in 1952 and 1953, at the annual meeting, the association voted
to urge the State and Territorial health departments to conduct a more
intensive promotional and educational i)rogram. In effect, that is the
same sort of a vote as taken in 1952 and 1953.
Will you describe briefly the type of i)rogram that you were urging?
Is there any literature that was provided for distribution? If so, of
what type was it, and how widely disseminated ?
Dr. Porterfield. The association, as such, sir, does not have funds
to carry out operations of any nature as an association. It confines
itself pretty much to its annual meeting and conferences of that ty]>e.
However, each of the individual State health officers has, in keeping
with his resources and interest, developed things. A number of the
States have developed educational or informational material on this
question of fluoridation.
They have also availed themselves of the resources both of the Public
health service and of the American Dental Association. Several of
them, I know, individually have collected a kit of their own by per-
sonal solicitation from the various authors who have published in
this field, both pro and con, in order to determine for tliemselves what
their policy should be, and then to promote that policy, that recom-
mendation, in the form of health education within their State.
408 FLUORIDATION OF WATER
Mr. Beamer. What about the situation in your own State of Ohio ?
Do you have such a kit available ?
Dr. PoRTERFiELD. Yes, sir. I don't have it available with me, but
such could be sent you.
Some of those would be duplicates of items you could receive from
other associations, but it is our particular collection in Ohio that we
use when a community expresses interest in considering this questior
Mr. Beamer. If you will do that, I think it will be very helpful.
Now, in addition to that, do you know whether or not the State
authorities send any agents or representatives around to the comjnu-
nities, either to explain what the State official position is or to attempt
to stir up interest in introducing fluoridation of the local public water
supply ?
Dr. Porterfield. Yes, sir. That would be in keeping with our gen-
eral operation. Most State health departments devote a considerable
amount of their activity to educational activity ; and in that connection
both dentists and health educators from the various departments would
travel in their State to communities, usually but not always on specific
invitation of the local dental societies or the local medical society or
the local board of health or citizens health council.
If I may etencl my remarks in xthat connection, however, this
question and would like to have information, when such requests come
in from the community, the State health department sends people to
provide that information. There is no gainsaying the fact that when
questions are not raised locally, the health educators and the dentists
and such people from the State health department may, in their visits
to local health departments, in discussing their overall programs, sug-
gest to them that one item in their program which they have not con-
sidered is fluoridation.
If I may extend my remarks in that connection, however, this
matter of promotion of fluoridation is within controlled limits. The
State health department in Ohio and I think, in most other States,
reserves the right to disapprove a community's desire to fluoridate
water if the engineers of the State health department have deter-
mined that its waterworks system and the personnel operating such
are not competent to provide a control program.
Mr. Beamer. Has that right ever been exercised, to your knowledge,
in Ohio?
Dr. Porterfield. Yes, sir ; not formally by the State health depart-
ment council action, but we have advised one or two small communities
that until they develop a proper water supply system and a properly
trained operator, we can't recommend to them that they consider the
question.
It has never gone further than that.
Mr. Beamer. Thank you. Doctor. That is all.
Mr. Hale. Mr. Pelly?
Mr. Pellt. Doctor, I would just like to ask you if in the State of
Ohio you have had local votes in communities on whether they should
or should not put in fluoridation ?
Dr. Porterfield. Yes, sir. There has been one that is well known,
in the city of Cincinnati.
Mr. Pelly. That is the only vote you know of ?
Dr. Porterfield. That is the only popular referendum of which I
know, yes.
FLUORIDATION OF WATER 409
Mr. Pelly. I asked Dr. Knutson before you came on the stand as
to whether or not teams of Federal workers had gone around to pro-
mote fluoridation, and you may have heard a gasp from certain in-
dividuals, who I think were proponents of the bill, indicating that there
was some doubt in their minds as to whether or not the public health
service had done it or not. Do you know in the State of Ohio whether
or not any State Public Health Service officials have gone around to
promote fluoridation ?
Dr. PoRTERFiELD. To the best of my knowledge, sir. Public Health
Service officials have not, of their own volition, come into the State of
Ohio and taken any community action. It depends, I think, a little bit
on the context of the question asked. Wlien the city of Cincinnati
was considering the question of fluoridation, the city health officer, the
health council of that city, the health federation, so-called, and cer-
tain other groups down there who were interested, sought the help and
advise of the State health department.
Our dental health chief and others, including myself, visited Cin-
cinnati, indulged in public forums in which both sides of the issue were
debated, both on television and in public meetings; and during that
time, which extended over several months, it may well be, although I
don't know this as a specific fact, that we had called in an employee of
the Public Health Service from the regional office to travel with us
or to advise us on certain material that was not immediately available
at first hand to us. So it is possible ; but not directly from the Federal
Government to the community ; not in Ohio,
Mr. Pelly. I can understand how a misunderstanding might have
arisen, and that possibly some local health authorities or State health
authorities had called in regional Public Health Service members to
travel to some community with them.
Dr. PoRTERFiELD. That is right, sir.
Mr. Pelly. That is all. Thank you, Mr. Chairman.
Mr. Hale. Thank you very much. Dr. Porterfield.
The last witness will be Dr. Harry Jordan, secretary of the Ameri-
can Water Works Association.
STATEMENT OF HARRY E. JORDAN, SECRETARY AND CHIEF
EXECUTIVE OFFICER OF THE AMERICAN WATER WORKS ASSO-
CIATION, BY DAVID AULD, DIRECTOR, AMERICAN WATER
WORKS ASSOCIATION
Mr. AuLD. Mr. Chairman, Dr. Harry Jordan was unavoidably pre-
vented from coming to this hearing.
He asked me to present his paper to you.
I am David Auld, a director of the xlmerican Water Works Associ-
ation. [Reading :]
My name is Harry E. Jordan. I have the honor to present to your committee
comments in opposition to the enactment of H. R. 2341 (Wier), to protect the
public health from the dangers of fluoridation of water.
I have for more than 50 years been concerned with the production and dis-
tribution of safe water supply. I am a graduate of Franklin College, holding
degrees of bachelor of science and doctor of science in chemistry. I am a life
member of the American Society of Civil Engineers, the American Public Health
Association ; and an honorary member of the American Water Works Association
and the New England Water Works Association. I have been since 1936 the
secretary and chief executive officer of the American Water Works Association.
410 FLUORIDATION OF WATER
The association, which is an organization of waterworks executives and
staff numbering 9,890 persons on May 1, 1954, adopted in June 1949 a statement
of policy concerning fluoridation of public water supplies which reads as
follows :
"In communities where a strong public demand has developed and the proce-
dure has the full approval of the local medical and dental societies, the local
and State health authorities and others responsible for the communal health,
water departments or companies may properly participate in a program of
fluoridation of public water supplies."
It will be noted that the association expresses no professional opinion con-
cerning the merits of fluoridation — but states that it relies upon the opinion of
trained physicians and dentists to advise local administrative authorities when-
ever it appears that fluoridation of a particular water supply is needed.
I wish to point out with full emphasis that the addition of fluorides to water
in a treatment plant is an operation involving no unusual procedures or equip-
ment. Fluorides are only one of a series of a large group of chemicals widely
used in water treatment ; carefully controlled by the operators in charge of the
system ; and no more likely to be fed in excess than any of the other materials.
The apprehension expressed by some opponents of fluoridation that careless
operation might poison a community is ridiculous. Such things simply do not
happen.
There also appears from time to time the statement that the addition of
fluorides to the public water supply is wasteful — since the proportion of the total
water produced in a city used for drinking is low. It is true that people drink
only about one half gallon per day out of the average of 140 gallons produced
per person per day. The same proportions affects the use of any treatment
material intended to make water safe for drinking. Fluoride-bearing minerals
are in ample supply to supply the needs for water treatment.
But it is just as true that it cannot be considered wasteful when we realize
Low great has been the value of modern water quality. In 1900 more than 50
persons per 100,000 living died each year from typhoid fever in the United
States. Today thanks to eflScient water treatment and the general increase of
sanitary protection of the people, less than 1 person per 200,000 living dies of
typhoid.
A reduction of such magnitude in waterborne disease should convince any
thinking person that the care taken to make all the water safe to drink is worth
many times over what it costs.
I shall leave to representatives of the dental and medical professions the
opportunity to present their opinions concerning the value of fluoride-bearing
water in prevention of, or reduction of dental caries.
You should, however, be advised that over 1,100 eonununities having a popula-
tion totaling over 3,500,000 persons have for many years used water supplies
containing fluorides naturally present in accepted amounts. As one trained in
the science of chemistry, I may state there is no significant difference in the
character of fluoride as it naturally occui'S in water and fluoride as it may be
added to water in amount recommended by the dental profession. Therefore,
the more than 17 million persons in over 900 communities, who have been fur-
nished in the years since 1945, water to which fluoride has been added in con-
trolled amounts are under no exposure to fluoride different from the 3,500,000
wlio liave for years used natural fluoride4>earing water.
However, speaking for the public water-supply industry which today serves
110 million persons in the United States, I wish to state my opinion that the
Congress cannot with propriety legislate what material may not be used in the
treatment of a public water supply. Similarly, I doubt that it could with reason
legislate what is to be used in water treatment.
The Federal Government today includes a large group of agencies upon which
Congress has conferred the duty of acting in areas assigned to each and con-
trolling procedures and practices, in their respective fields. The Congress has
established among others, the Department of Health, Education, and Welfare
and has granted it powers, which among other things, cover dental health and
quality of water used in interstate commerce. Consistent with the authority
given by the Congress, staff members of the Health, Education, and Welfare
Departiiient have, with full professional competence, investigated fluoridation
and have announced their opinion that controlled addition of fiuorides to public
water supplies is proper and highly desirable.
Unless the Congress has available to it a mass of professional evidence which
shows that the Government's own agents are professionally incompetent, it is not
FLUORIDATION OF WATER 411
proper for legislation to run counter to the opinion of the Government's own
experts.
I wish, however, to object on broader grounds to a legislative enactment which
will forbid the use of a water-treatment material recommended by competent
professional authority. The water worlis industry now uses widely two chemi-
cals in purification to which objections were once made by persons presumably
well informed.
The Army engineers, wlio about 1900 reconunended purification of the Wash-
ington, D. C., water supply by means of coagulation with alum followed by fil-
tration, was opposed in a hearing before a Senate committee by a group repre-
senting the District medical society. The v»ater treatment phint, was, tliereiore,
built so as to operate without coagulant. But in less than 5 years after the
plant was built it was found necessary to use alum. It had been learned that
the system cotild not function satisfactorily without alum. Its use continues
to this day — witlt restilts satisfactory to tlie operators, to the medical profes-
sion, and to the public. Today there are more than 2,000 cities in the United
States using water treated with alum or its functional equivalent.
In 1910 the use of chlorine as an agent to destroy bacteria in water was being
widely considered. Dr. Harvey W. Wiley, then Chief Chemist of the Depart-
ment of Agriculture, when asked a question about the propriety of using chlo-
rin, stated (without studying the question carefully) that "chlorine in water
is as much an adulterant, as formaldehyde in milk." Fortunately, for the public
good, Dr. Wiley's comment gained little attention. The use of chlorine spread
and the evidences of its great benefit grew. Today more than 3,500 communities
in the United Stales drink safer water because chlorine is used to remove the
last bacteria which may have polluted it.
If your committee had been in existence in 1902 and the opposition to alum
as a coagulant had led you to recommend that alum or its equivalent not be
used in water purification, you would have been in error — as history now
shows.
If your committee had been faced with the opposition to chlorination in
1910, you might have been led to recommend legislation forbidding the use
of chlorine in water treatment. You would have been in error — as history
now demonstrates.
In the last 50 years, improvements in the quality of public supply — improve-
ments made possible because valid progress was not hampered by adverse
legislation — have saved the lives of at least 5 million persons who would
have died of waterborne diseases if the water-supply industry had not kept
in step with the advances in scientific knowledge.
I therefore appeal to you — as reasonable and intelligent public servants —
not to recommend legislation forbidding the fluoridation of public water sup-
ply. Let the decision to fluoridate or not to fluoridate be left to the State and
local authorities and let them base their action upon the advice of the medi-
cal and dental professions.
Mr. Beamer. I have no questions to ask, but only a comment to
make. Isn't it a fact that not too many years ago some people
thoujiht it was dan^jerous to bring water through copper pipes?
Mr. AuLD. I think that did come under study, yes: lead, too.
Mr. Beamer. Once upon a time isn't it true that the tomato was
considered a poisonous fruit?
Mr. AuLD. Eight.
Mr. Beamer. I had the opportunity to have passed around some
good Indiana tomato juice to my colleagues recently, and they en-
joyed it. And I am trying to point out what I think you are trying
to point out, that as we advance in science and the development of
products, something that may have seemed injurious at one time has
been proved not to be injurious but rather helpful.
Mr. AuLD. Time has seen that repeatedly in many fields. And it
would seem unfortunate to stop it by legislation at this time with
respect to fluoridation.
ISIr. Hale. Thank you.
48391 — 54 — —27
412 FLUORIDATION OF WATER
Mr. AuLD, Tliank you, Mr. Chairman.
Mr. Hale. This will conclude the hearings on H. K. 2341.
When the committee adjourns, it will adjourn to meet tomorrow
morning at 10 o'clock.
At this point we will insert statements of opponents of the bill
which have been submitted for the record.
I have a letter from the Honorable John W. McCormack enclosing
a telegram from a number of doctors ;
A letter from Dr. Clifton O. Dummett, Chief, Dental Service, Vet-
erans' Administration, Tuskegee, Ala., enclosing some information;
A. letter from Dr. Francis Lehr of the New Jersey State Dental
Society ;
A letter from Dr. Earl G. Ludlam, New Jersey State Department
of Health;
A letter from Dr. Thomas Parran, former Surgeon General of the
United States ;
A letter from Francis J. Garvey of the American Dental Associa-
tion ;
A letter from the Plainfield Dental Society, Plainfield, N. J. ;
A letter from Dr. George F. Lull, secretary and general manager,
American Medical Association ;
A letter from Katherine Ellickson, CIO ;
A letter from A. P. Black of the University of Florida ;
A letter from Dr. Kenneth F. Maxcy of Johns Hopkins University ;
A letter from Prof. Harold C. Ploclge, of the University of Rochester.
(The statements referred to are as follows : )
Congress of the United States
House of Representatives,
Office of the Democratic Whip,
Washington, D. C, May 25, i95Jf.
Hon. Charles B. Wolverton,
House Office Building, Washington, D. 0.
Dear Chairman Wolverton : I am enclosing a telegram received from Dr.
James M. Faulkner and a number of other doctors in opposition to H. R. 2341,
which I am respectfully sending to you without comment on my part for the
information of yourself and the other members of your committee.
With kind regards, I am
Sincerely yours,
John W. McCormack.
Boston, Mass., May IS, 195^.
Representative John W. McCormack,
House of Representatives, Washington, D. C.
We the undersigned Massachusetts public officials, research workers, teachers
and Representatives of voluntary organized medicine and dentistry urge the
defeat of H. R. 2341. We believe that fluoridation of communal water supplies
by one part per million a safe and effective measure to combat dental caries and
That the passage of H. R. 2341 would be a serious step backward in this
important phase of the public health.
Dr. James M. Faulkner, Dean, Boston University School of Medicine;
Dr. Roy A. Greet, Dean, Harvard School Dental Medicine ; Dr.
James F. Simmons, Dean, Harvard School of Public Health ; Dr.
Cyril D. Marshall-Day, Dean, Tufts College Dental School; Dr.
Joseph M. Hayman, Jr., Dean, Tufts College Medical School ;
Dr. Frederick Stare, Professor of Nutrition, Harvard School of
Public Health ; Dr. James H. Shaw, Assistant Professor of
Dental Medicine, Harvard School of Dental Medicine ; Dr. Reidar
F. Sognnaes, Professor of Oral Pathology and Assisting Dean of
Harvard School of Dental Medicine; Dr. James M. Dunning,
FLUORIDATION OF WATER 413
Chairman, Health Division of Cambridge Community Services;
Dr. Hugh Lea veil, President, American Public Health Association ;
Curtis M. Hilliard, Supervisor of Department of Public Health,
Wellesley, Needham, and Weston; Dr. John F. Conlin, Director,
Public Information and Education, Massachusetts Medical
Society ; Dr. Edward R. Loftus, Chairman. Special Fluoridation
Committee, Massachusetts Dental Society ; Dr. Edwin T. Holmes,
Chairman, Council on Dental Health, Massachusetts Dental
Society; Dr. George J. Fink, President, Massachusetts Dental
Society; and Dr. Harold E. Tingley, Secretary, Massachusetts
Dental Society.
Veterans' Administration,
Department of Medicine and Surgery,
Tuskcgee, Ala., May 11, 195J,.
Representative Charles A. Wolverton,
Chairman, Interstate and Foreign Commerce Committee,
House of Representatives, Wasliington, D. C.
Dear Representative Wolverton : The purpose of this short note is to express
my opposition to the Wier bill, II. R. 2341 which seeks to prohibit fluoridation
of public water supplies throughout the United States.
The evidence in favor of fluoridation is overwhelming and it seems so unreal
that there should be as much emotional opposition to a measure which has so
much good to support it.
I am enclosing for your information some articles on the proceedings of a
conference which was held here last year which surveyed most of the material
in the field. I am calling your attention especially to pages 69 to 103. I feel
that you would be very much interested in this material. My hope is that this
bill will be defeated.
Very sincerely yours,
Clifton O. Dummett, D. D. S.,
Chief, Dental Service.
The Dental Caries Problem and Its Impact on Everyday Life
(Carl L. Sebelius)
There exists today among our people a very great need for more adequate
dental service. This need has become recognized throughout the country since
greater emphasis is now being placed on the importance of early and regular
visits to the dentist, as well as certain preventive dental procedures which, if
applied, are known to reduce the incidence of dental caries. The two' pi-ocedurcs
which have been shown to be the most effective are the topical application of
fluorides to the teeth and the controlled fluoridation of the municipal water
supplies.
In order to give you a picture of the dental caries problem among children,
I wish to present certain facts which have been taken from the dental examina-
tions made by members of the Dental Service of the Tennessee Department of
Public Health. I doubt very much if the figures would be much better in other
communities of the South. For instance, during a 2-year period, dental personnel
of the Dental Hygiene Service examined over 12,000 children, G to 8 years of age,
in random schools in over 40 counties of Tennessee. These examinations showed
over 6 dental defects per child and over 89 percent of the children in need of
some type of dental service. Some may say, why so much fuss about the dental
needs of children? I should like to emphasize that these children were found
to have an average of 18 cavities for every filling and it is known that if bite-
wing X-ray examinations had been made, the number of cavities would have been
much greater.
Today, w^hen a dental program is established in a community it is common
for the dentist to limit his services almost entirely to the extraction of hope-
lessly decayed teeth. Certainly such a program is not ideal in any respect.
This tremendous need for more adequate dental care for the children may be
due in part to the apathetic attitude many people have toward dental disease.
A great group of our population attaches relatively little importance to dental
disease found in our child population. Many consider it commonplace, even
414 FLUORIDATION OF WATER
trivial, and an unavoidable nuisance, an attitude somewhat similar to our feel-
ings in regard to the common cold. This commonplace acceptance constitutes a
real danger and an obstacle to progress in dental public health. There are others
who say that the problem is too great to attack and that dental disease lacks in
public appeal.
Another example of why there is such a dental health problem, especially
among children, was recently reinforced when in Oslo, Norway, I had the privi-
lege of seeing that dental program in operation and examining the teeth of about
1,000 children who were 9, 11 and 13 years of age. In Oslo, the city spends
approximately 1 percent of its tax money on its dental program for children.
There are no fluorides in the water, and in order to attempt to control dental
decay among the children, the city has established over 50 dental clinics with
20 chairs used for children under 7 years of age. There are 100 full-time den-
tists working in Oslo's public service program for children. Even though the
city has a population of about one-half million people, the dentists are finding
it almost impossible to give complete dental care to the schoolchildren's per-
manent teeth. It was interesting, however, to observe that practically no per-
manent teeth were missing and that in Oslo there are 400 dentists in private
practice working primarily for adults.
I think you would be interested in certain restrictive regulations which have
been set up so that the dentists can keep up with the dental needs of these
children :
1. Preschool children must enter the service at 3 years of age. If a i-equest
for admittance to the service is made after that age, the child must have already
received complete dental care, usually from a private dentist.
2. A child entering school at the age of 7 receives complete care of the decid-
uous teeth only if he has previously had these teeth cared for.
3. All young people 14 to 18 years of age must have received dental service
during their school period to be eligible for dental service. It also must be
realized that most of the school dental programs in Scandinavia have been' in
operation for 30 to 50 years and that it is the exception where a child in school
has never visited a dentist.
If these children had always received fluoridated water, it seems most reason-
able to think that probably 35 or 40 dentists might do the work now requiring
100 dentists and 160 assistants.
The dental caries problem does have an impact on everyday living. On page
16 of the March 1952 issue of Today's Health, are the following 3 paragraphs
on preventing tooth decay :
"Badly needed is more research to find ways of preventing the enormous waste
of human teeth," Col. John R. Wood, chairman of the Medical Research and
Development Board, Office of the Army Surgeon General, told the American
Pharmaceutical Manufacturers' Association.
"More than 40 percent of men entering the services in World War II needed
immediate treatment to save their teeth about to be lost, and one-third of them
needed treatment for toothaches. Five percent needed new teeth to have enough
to chew with. Even today, our troops are losing collectively well over a million
teeth per year. The cost of this care, at the most conservative civilian rate,
exceeds $80 million a year. Yet, only about a million dollars a year is being
spent on dental research, only part of that on methods of halting this waste."
Recently in the Journal of the American Dental Association there appeared
an article which stated that in 1950 approximately $1 billion was spent in this
country for dental service. When the people of our country spend $1 billion or
more per year for dental service, surely dental research is deserving of more
than $1 for every thousand dollars spent; $110 for every thousand was being
spent for medical research. I feel that it is time that more support and empha-
sis be placed on the creation of a higher level of dental health in this country.
As a member of the National Advisory Dental Research Council, I know that
many acceptable dental research projects cannot be started because of a lack
of funds.
We could talk for a long time as to why a dental health problem exists, the
psychological, economical, educational, and professional problems involved, yet
dollar per dollar dental research in the field of dental caries control has paid
tremendous dividends. The present trend seems to be directed toward the
restricted use of refined carbohydrates, the use of topically applied fluorides, the
fluoridation of public water supplies, and the proper use of the toothbrush espe-
cially following the consumption of fermentable sugars. There certainly is a
FLUORIDATION OF WATER 415
trend toward roore research in the field of dentifrices which may effectively
assist in the control of dental caries.
In this country there has developed a trend to discourage the sale of sugars
in the schools. In the fall of 1950, the council on dental health of the American
Dental Association adopted a resolution which requested that the sale of candy,
soft drinks, and other confections be discouraged in our schools. In the INIay
1950 issue of the Journal of the American Medical Association, the council on
food and nutrition gave its reasons why carbonated beverages should not be
sold on school premises. In August 1951 the National Congress of Parents
and Teachers went on record as being in favor of banning the sale of candies
and carbonated beverages in the schools of our Nation.
The use of fluorides, especially the fluoridation of public water supplies, is
rapidly developing into a comprehensive nationwide movement. The division
of Dental Public Health of the United States Public Health Service considers
the promotion of controlled fluoridation its priority 1 project. This is also
true of the divisions of dental health of State health departments of this coun-
try, as well as dental society groups.
The committees of workshop, public relations, and dental health of the
Tennessee State Dental Association recently conducted a workshop which had
as its theme, "Help Yourself to Water Fluoridation." The meeting was attended
by over 100 dentists, health workers, educators, invited guests and representatives
of lay and civic groups. The workshop was planned with the same objective
in mind as I am sure Dr. Dummett and his committee had in arranging this
symposium ; namely, that all individuals interested in dental health might think
together, plan together and work together toward a goal of better dental and
general health.
The controlled fluoridation of water is a start in the right direction. There
is evidence as to the benefits to be obtained and we need to promote the pro-
cedure with the thorough and firm knowledge that, if the people of a town
want fluoridation, they have it — but they must want it and they must say
so. Since the city official is very sensitive to community spirit, it must always
be realized that 1 phone call against the practice of fluoridation will cancel 20
phone calls asking for it. Those of us in the field of dental public health feel
that everyone should have the facts and if they have the facts they will be
for water fluoridation. We think that fluoridation will rank with the major
public-health movements of all time, and we hope that everyone interested
in this most worthwhile public health program will inform others and actually
start what might be called a chain reaction so that, within a relatively short
period of time, fluoridated water may be made available in every community
where there is an approved water supply.
Water Fluoridation
(Sidney B. Finn)
We have heard from Dr. Sebelius about the magnitude of the dental caries
problem. As he has suggested, if there is to be a solution to this problem,
it will come through prevention, and if prevention is to make progress in
eliminating the vast reservoir of untreated cavities for future generations, pre-
ventive means must be applied to large segments of the population. This would
be most feasible as a public health measure on a population basis. I can think
of no better way of reaching the entire population equitably than through a
community water supply. Water is the only commodity consumed consistently
by all persons. It is highly advisable that any agent or chemical used for the
purpose of reducing dental decay for the entire population should have five
important requisites: (1) It must be of unquestionable value, (2) It must be
relatively inexpensive, (3) it must be safe to use, (4) it must be easily utilized
on a population basis, and (5) it must require little or no effort on the part of
the individual benefited.
It cannot be denied that there is more than one way of reducing dental caries.
Carbohydrate restriction, topical fluoride applications, rigid adherence to the
rules of oral hygiene, all are capable of doing good. However, each falls short
of what is desired in one or more ways. Water fluoridation or the treatment of
a communal water supply with 1 part per million of fluorine, in the form of a
fluoride, meets the requirements of a preventive agent more adequately than
416 FLUORIDATION OF WATER
any ever suggested. So much so, in fact, that I can have no hesitation in strongly
recommending this form of dental decay prevention for every community with
a supervised communal water supply. Nowhere in medicine or dentistry has a
preventive agent had such a vast amount of irrefutable evidence to recommend
it, and I may add, so little reliable, confirmed evidence against it. If one studies
the bibliography on water fluoridation, one is immediately impressed with the
vast amount of epidemiological and experimental evidence that has gone into
the establishment of the fluorine-caries hypothesis. As early as 1867, Magitot
suggested that fluorine was associated in some way with the integrity of the
tooth.
In 1892, Sir Crichton Browne, writing in the British Medical Journal, Lancet,
indicated that teeth contained more fluorine than any tissue in the body, and
that fluorine was there for a reason and that the reason was to prevent dental
decay. He suggested that foods rich in this element should be incorporated into
the diet of children for that purpose.
From 1908 to 1916, Doctors Black and McKay thoroughly studied a pathologi-
cal condition of the teeth endemic among those reared in certain limited areas
of Southwestern United States. Among these individuals the teeth were poorly
formed, stained, and pitted. To this disfiguring disease, they applied the term
"mottled enamel.'' They observed that mottled enamel could be acquired only
if persons resided in these areas during the period of tooth formation, and once
acquired it remained for life. They further observed that people moving into
these areas after their teeth were formed did not acquire this disease. They
also established that the cause of mottled enamel was in some way waterborne.
In 1931, through chemical analyses of water, and through animal experi-
ments, it was discovered that mottled enamel was caused by excessive amounts
of fluorine in the drinking water supplies. In 1938, Dean and his associates
reexamined these endemic areas in Southwestern United States and other areas
in the Midwest where fluorosis was endemic. They determined that the severity
of the fluorosis was directly proportional to the fluorine content of the water
consumed. Esthetically significant, mottling occurred only in individuals con-
suming over 1.5 parts per million of fluorine. Their epidemiological studies
further indicated that those individuals consuming water containing 1 part per
million of fluorine or over had approximately 60 percent less dental caries than
was found in neighboring communities where fluorine-free water was consumed.
They also made the important deduction that the reduction in dental caries was
not inversely proportional to the fluorine content of the water supply. As a
matter of fact, there was just as great a reduction when the water contained 1
part per million of fluorine as when it contained 14 parts per million, and one
did not get disfiguring fluorosis. These observations by Dean and others from
different areas of the world, received additional confirmation from animal ex-
periments and from chemical analyses of the fluorine content of sound and
carious teeth. Recent studies indicate that this resistance to caries, once ac-
quired, persists throughout lifetime. There are actually 8 million persons in the
United States consuming water containing 1 part per million of fluorine or over,
naturally in the water supply.
The question soon presented itself as to why couldn't fluorine be added arti-
ficially to the water supplies in areas where fluorides were deficient. In
19.39, Cox, speaking before the Pennsylvania Water Works Association, first
suggested artificial fluoridation. By 1945, a number of communities in the
United States were fluoridating their water on a demonstration basis, for
although naturally fluoridated waters reduced the incidence of dental caries,
it was still to be proved that artificially fluoridated water would do the same.
In 1944, the New York State Department of Health initiated the Newburgh-
Kingston study, with dental examinations of all the school children in New-
burgh. It is not the intent of this paper to discuss the results of all studies
published to date. This will be done by the next speaker. I would like to
confine my remarks to the Newburgh study, with which I was associated since
its inception.
Newburgh, N. Y. is situated on the Hudson River, 60 miles above New York
City. Its water supply was fluoridated with 1.2 parts per million of fluorine
as sodium fluoride, May 2, 1945. Kingston, a similar sized city, situated 30
miles above Newburgh continued to drink fluorine-free water and served as
the control. Yearly dental examinations were made with mouth mirror and
explorer under good light on the entire school population of over 3,000 chil-
dren in each city. At the end of a 4-year period of fluoridation all 7-, 9-, and
FLUORIDATION OF WATER 417
11-year-old children were X-rayed to determine whether X-rays would confirm
our clinical findings. The X-rays did confirm our clinical findings.
In the pernuineut teeth of the 0- to 12-year-old children, dental caries ex-
perience was reduced 32.5 percent. Among the G-year-olds, the reduction
amounted to 77.G percent. Since about 70 percent of all tooth decay develop-
ing in the permanent teeth of children occurs in the 6-year molar, it was of
interest to see if there was a reduction in dental caries there. In the 6- to
9-year-age group, 59 percent of the first permanent molars were caries-free
before the study, while 77 percent were caries-free after 4 years of fluorida-
tion, lu the deciduous teeth of children 5 years of age 27.2 percent were
carious prior to fluoridation. Only 10.9 percent were carious after 4 years of
fluoridation. Caries activity after 4 years as indicated by salivary bacterial
counts indicated less activity in these mouths.
Another part of the Newburgh-Kingston study deals with medical aspects.
In the literature are many reports about the harmful effects of fluorides. Un-
fortunately these reports make no distinction between toxic and nontoxic
doses. Those who have actually had the greatest experience with fluorides
believe that in quantities of 1 part per million fluorine no deleterious effects
are observed. To determine the truth about this, a complete medical study
on over 600 children in Newburgh and 600 in Kingston has been undertaken
on children from birth to 14 years of age. These children receive complete
physical examinations which consist of height and weight measurements, ex-
amination of body organs, blood counts and hemoglobin, urinalysis, X-rays
of long bones and centers of ossification, visual-acuity tests, and audiometric
examinations. I can say without equivocation that after 7 years of fluorida-
tion no difference has been observed between the children of Newburgh and
Kingston. The children of Newburgh are not suffering from malnutrition,
kidney damage, or any other pathology any more than the children of King-
ston or any other community. As a matter of fact the children of Newburgh
are healthier ; they have less tooth decay.
In speaking of water fluoridation, there are several fluoride compounds avail-
able for this purpose. Among these are sodiiim fluoride, hydrofluoric acid, and
sodium silicofluoride. For small cities and towns sodium fluoride is recom-
mended. Because of its solubility it is readily adaptable for use in inexpensive
feeding equipment and the chemical is available in moderately abundant supply.
In considering the toxicity of fluorides, my remarks will be limited to a dis-
cussion of sodium fluoride. Sodium fluoride is a white crystalline salt. In
commercial form, it is dyed nile green or light blue to distinguish it from other
salts that are white. It is a very toxic substance, 4 or 5 grams or a tablespoon
being a fatal dose. Yet in quantities of 1 part per million fluorine, it is per-
fectly safe to use in communal water supplies. One part per million is a very
small amount. One way of visualizing this amount, is that if one drinks on
the average of 2 quarts of water a day containing 1 part per million fluorine he
consumes, roughly 4 milligrams of sodium fluoride. Since 4 grams or 1 table-
spoonful is a lethal dose, to get this amount, one would have to consume 1,000
times the amount of water he normally drinks in a day at 1 time, or 500 gallons
of water at 1 sitting, which is an impossibility. One-quarter of a gram of sodium
fluoride, when swallowed at one time may produce nausea and vomiting. In
terms of fluoridated water, instead of the customary 2 quai'ts a day, you would
have to drink 125 times that much, or 03 gallons at 1 time— again an impossibility.
"We hear from those opposing fluoridation, that fluoridated water might pro-
duce crippling fluorosis. This is observed only in areas where the residents
consume at least 20 milligrams of fluoride a day over a period of 10 to 20 years.
In case of water fluoridation at 1 part per million of fluorine, instead of 2 quarts
of water a day, one would have to drink at least 2i/4 gallons of water daily over
a 10- to 20-year period, which is again over 10 times the average daily water
consumption. As Cox and Hodge put it, "It is impossible to imagine any set of
circumstances in which the fluoride might become sufficient to bring about
chronic high-grade fluorosis." In using 1 part per million of fluoi-ide in the
water supply, there may be some possibility of getting mottled enamel, if water
consumption, during the formation of the teeth, was greatly increased day in
and day out. However, water consumption in an area is fairly constant and it
is highly doubtful whether any mottling produced would be of sufficient import
to be esthetieally significant since it would prol>ahly he of the very mildest type.
The question is often asked whether there was danger of getting a lethal dose
if the machine should become defective. Roughly 20 pounds of sodium fluoride
418 FLUORIDATION OF WATER
are required to treat each million gallons of water at the 1 part per million
fluoride level. To get 4 grams at 1 time would require, not 20 pounds per million
gallons water, but 10 tons per million gallons water. No machine or human
could make that error for the capacity of the machine AA-ould not be that great.
As a matter of fact, in discussing toxicity, there are many instances that can
be cited where a chemical may be lethal in large amounts and beneficial in small
amounts. Iodine, for instance, is poisonous in large quantities. Most of you
have seen the "poison" label on a bottle of iodine. Yet in small quantities it is
absolutely essential for the maintenance of life. Chlorine, used to kill bacteria
in most of our water supplies, when used in minute proportions, was used as a
poison gas in the First World War. Even common table salt, if consumed in
large quantities, may produce death. Sodium fluoride is another example of a
chemical, toxic in large quantities, and beneficial in small, controlled doses.
How fluorides work to produce this reduction in dental caries has still not
Iieen completely settled. When consumed in the water supply during formation
of the teeth it probably changes a portion of the crystalline structure of the
tooth from a hydroxylapatite to a fluorapatite. We know from minerology that
the fluorapatite rocks are very hard and very resistant to acid erosion. We
now believe that dental caries is caiised by the action of oral bacteria on sugars
and carbohydrates in the mouth. The sugars are converted to acid, and the acid,
initiates the carious lesion. If we can ))uild a tooth structure resistant to these
acids, then it should be resistant to tooth decay. We believe that this might be
one explanation for the action of fluorine. When consumed in communal water
supplies over a great number of years, even in minute quantities of 1 part per
million, there may be some topical or surface action. As an analogy, it is like
Imilding a house of stucco. If you want a green house yon can either include
the green paint or pigment in the plaster, or you can apply the green paint to the
surface after the plaster has set. By either means, the result is a green house,
although the green paint incorporated in the plaster will probably last longer.
SUMMARY
In summary, may I say that there is evidence to indicate that fluorides used
in communal water supplies will reduce dental caries. The reduction once
acquired should persist for life. There is absolutely no reliable evidence to
indicate that 1 part per million of fluorine incorporated into the communal
water supply will produce deleterious effects. It is recommended that any com-
munity that has a supervised communal water supply should fluoridate its
water.
Better Dental Health Thiiough Water Fluoridation — A Peogress Report
(Zachary M. Stadt)
introduction
The purpose of this first Public Health Institute, as noted by Dr. Dummett, is
to bring together the most promising or currently best thinking in the several
fields of public health, with special emphasis on their application to the health
needs of people in the rural areas.
Water fluoridation, as a proved method for the mass partial prevention of
dental decay, can l)e applied wherever there is a community water-distribution
system. Today, Norwood, Wash., with a population of 150 people, is adding
fluoride to its water supply for expected dental health benefits. In time, it
should be possible to assure that all water supplies, private or communal, will
have beneficial fluoride concentrations.
BROAD endorsement
The evidence demonstrating dental health benefits derived from water-borne
fluorides is so overwhelmingly abundant and constantly increasing, that the meas-
ui"e is now endorsed by important international, national, and local groups con-
cerned with health. Those organizations and agencies include the Interassocia-
tion Committee which is composed of the American Dental Association, the
American Medical Association, the American Hospital Association, the American
Nurses' Association, the American Public Health Association and the American
FLUORIDATION OF WATER
419
Public Welfare Association. Other endorsers are tlie Federation Dentaire Inter-
nationale, the National Research Council, the United States l*ublic Health
Service, the State and Territorial Health Officers, the State and Territorial Dental
Health Directors, the American Association of Public Health Dentists, the
majority of State dental societies, many State health departments, an increasing
number" of State medical societies, and hundreds of county dental and medical
groups, boards of health, local professi(mal organizations, and lay organizations
such as the Jaycees, Rotarians, Lions, and Kiwanis.
TROWTH AND DEVELOPMENT OF FLUORIDATION
Among those who have contributed to a better understanding of the fluorine-
dental caries relationship are the moderator of this symposium, Dr. J. F. Volker
(1) and our essayist Dr. S. B. Finn (2). From their observations and those of
others (3) and (4) the adaptation of observed phenomena to practical applica-
tion was but one step. On August 19, 1942, Dr. W. L. Hutton, health oflicer, pro-
posed to the Brantford, Ontario, Board of Health that w^ater fluoridation should
be established for dental health benefits. The Provincial authorities refused the
request (5).
In 1945, four studies were started: (a) Grand Rapids-Muskegon in Michigan;
(6) Southbury-Mansfield, Conn.; (c) Newburgh-Kingston, N. Y. ; and {(I) Brant-
ford-Sarnia, Ontario, Canada. The number of people involved in the 4-study
areas totaled around 240,000. From 1945 to 1950 growth was slow, increasing
to some 44 places in 14 States. The big spurt in 1951 followed endorsement by
the United States Public Health Service, based on findings derived from their
Grand Rapids, Mich., study and the endorsement by the American Dental As-
sociation.
The following comparison illustrates the rapid increase in fluoridation during
the last year (the figures are not absolute) : (see table I).
THREE PERCENT OF 1.5,000 WATER SUPPLIES HAVE FLUORIDATION IN OPERATION
OR APPROVED
In his report to the State and Territorial health officers, Knutson (6) noted
that (a) 93 percent of all public water supplies are in communities of 10,000
population or less, (ft) that of the 16,750 public water supplies in this country
Table 1
. — Status of fluoridation
Status
Year
States
Places
Populations
A. In operation -
April 1951
21
137
12
40
12
35
83
192
93
250
167
212
2, 363, 222
B . Approved
C. Under consideration
March 1952
April 1951
March 1952
April 1951
March 1952
April 1951
5, 664, 108
5,251,903
13, 750, 024
14.701,317
17, 396, 540
Total, A, B, and C
45
45
343
654
2 22, 316, 442
March 1952 _
2 36, 810, 662
' 37 States and District of Columbia.
2 If we correct the totals for population increases and those on the distribution systems who are not in-
cluded in the community census, we could add 5 percent, hence the April 1951 total would be 23,432,264 and
the March 1952 total would be 38,651,195.
some 15,000 do not contain natural fluorides, and (c) that at the present rate of
development it would take 150 years to complete the job of getting all the water
supplies fluoridated.
At the present time some 200 communities are fluoridating and around 250
others have registered their approval, for a total of 450 places or 3 percent of
the 15,000 communities with fluoride-deficient water supplies. If all 450 places
should be in operation in the near future, they would represent a total popula-
tion of some 20,000,000 people, or one-fifth of the 100,000,000 people on community
w^ater distribution systems. How long will the remaining 14,550 communities
with their SO million population continue to deprive themselves of this assured
method of mass partial prevention of dental decay? It is the .lob of all of us
here to see that the job is done in the next 5 years, not the next 150. Of course,
it is a big job, but it gets easier every day.
420 FLUORIDATION OF WATER
IMPOETANCE OF DENTAL EXAMINATIONS
Water fluoridation promotion represents an opportunity for dental liealth
education in a dramatic and impressive manner. Today many communities
have one or more responsible health workers who have some knowledge con-
cerning the extent of the dental-health problem. Any or all of these health
workers will be interested in bringing the dental-health problem into controllable
limits.
General knowledge about the dental-health problem is not enough. Practically
everyone knows something about dental decay and diseases of the tissues which
support the teeth, but how many hear or read specific dental-health facts for
their own particular community? Because the answer to this question is very
few, there should be made available reliable statistics on dental health. To
obtain information about the extent of the dental-caries problem, dental exami-
nations should be done on selected age groups. The proposed dental examina-
tions can be done by the dentists or dental hygienists provided by the State
department of health or by local dentists or dental hygienists employed by the
local health department.
COOPERATION OF PAKENT-TEACHER ASSOCIATION
When members of the Parent-Teacher Association act as recorders for the
dental examiners it gives each parent first-hand information concerning the
dental-health problem. Her observations are carried into the meetings of the
Parent-Teacher Association with effectiveness. This can be the beginning of a
drive to tell the people about the dental-health problem in the community. If
there is no PTA, influential mothers should be drafted as recorders.
The dental examinations should be as extensive as possible, covering broad
age groups. In all of these undertakings there is an important emphasis on the
dental needs of children, but the long-range basic dental examinations should
include representative groups at ages 20, 30, 40, 50, and 60.
The figures obtained from analysis of these examinations will provide a base-
line against which future information can be compared. Of greater importance
is the fact that it will be possible to tell the home folks the facts about the
immediate dental-health problem in the communit.v. When presented to the
community in this way, dental-health statistics will begin to have the same
significant impact on the people as information relating to VD, TB, cancer,
cardiovascular-renal diseases, and infant and maternal mortality .
Standardized dental examination procedures can be arranged by the State
dental director consulting with representatives of the State dental society, so
that comparisons of dental findings from various communities will have a high
degree of validity.
THE DENTAL PROBLEM AND EXPECTED BENEFITS FROM FLUORIDE
White children
Figure 1 combines Dean's graph (7) and (8) with Charlotte (N. C.) (9) data,
all pertaining to children in the 12 to 14 age group. Using this information it is
possible to demonstrate the fluorine-dental caries relationship in a practical
way. Using Aurora as an example of what can be expected at around 1 to 1.20
parts of fluorine to a million parts of water, one can round off the figures and
show that Charlotte white children (per 100) have 5 times as many teeth missing
(60 to 11.4) almost 5 times as many teeth requiring extraction (17 to 3.5), twice
as many teeth that have untreated caries (353 to 166.7), and more than 4 times
as many teeth filled (418 to 99.4). For Charlotte white children age 12 and 14
there are 418 teeth filled and 60 extracted or a total of 478 teeth treated per
100 children. If the dental-caries experience at Charlotte for the 12- and 14-
year-olds should be reduced to that observed at Aurora, then it should be possible
to predict that after 14 to 15 years of fluoridation, with the same amount of
services available, there will be few if any teeth with untreated dental caries
and the few necessary extractions will have been fully taken care of, with a
surplus of 197 services available for other age patients.
The data for Waukegan, 111., and Charlotte. N. C, are particularly interest-
ing because of the remarkable decree of similarity in findings and because the
data represents the findings of Dean and his coworkers for Waukegan in the
1939^1 period, while the Charlotte data are derived from dental examinations
by members of the Charlotte Dental Society and the speaker. Waukegan and
FLUORIDATION OF WATER
421
Charlotte will be cited in that order : Teeth extracted 69.5 and 60, extraction
required 16.5 and 17, untreated decayed teeth 363.1 and 353, and teeth filled
361 and 418. Total dental-caries experience per 100 children : Waukegan, 810 ;
Charlotte, 848.
Negro children
The importance of water fluoridation as a dental public health measure is
brought into full relief when we examine the graphic analysis of the dental
caries experience of Charlotte (N. C.) Nesro children in the 12 and 14 age
groups. The most striking figure is the number of teeth filled 29 per 100 children,
or only 4 percent of the teeth attacked by decay ; { Charlotte white children in
the same age groups have almost 50 percent of their defective teeth filled.)
Eighty-three percent of the teeth (605 per 100 children) have untreated dental
decay.
REPORTS FROM STUDY AREAS
The data in the following tables give factual support to the benefits predicted
from the fluoridation of community water supplies.
Table 2. — The eftect of fluoridated water on the number of caries-free children
Place
(a) New York:
Newburgh.
Kingston '
(6) Brantford, Ontario,
Canada.
Sheboygan, Wis.:
(c) Kindergarten.
(d)
Evanston, HI.
(e) Ottawa, Kans.:
No def teeth...
No DMF teeth.
Madison, Wis.: No def sur-
faces.
Refer-
ence
(10)
(11)
(14)
(15)
(16)
Fluoridation
Started
May 1945- -.
do
June 1945...
March 1946_
do..
February 1947.
September 1946.
do
June 1948
Elapsed
time
(months)
61-66
5- 6
5- 6
5-16
12-14
Caries-free (percent)
Before
fluorida-
tion
18.2
19i5-i6
21.9
19U-45
5.18
October-
Novem-
ber 1945
20.4
Febmnry-
Mnrch
19i'2
2.77
19J,(',
41.04
11. 33
6.09
11.55
Septem-
ber WlfG
25
13
76
59
25.56
After
fluorida-
tion
1950-51
49.2
1950-51
30
1951
15.97
Septem-
ber 1951
47.8
October
1951
3.4
19i8
1.5. 87
8.71
8.18
11.26
January
1951
23
17
79
66
46. 76
Percent
Increase
(I), de-
crease
(R)
I 170
I 37
I 208
I 134
I 23
R 24. 57
R 23. 12
I 34.31
R 2.5
1 Control city: (a) Percent children with caries-free deciduous cuspids, 1st and 2d molars; (b) no def-DMF
deciduous or permanent teeth; (c) no def deciduous teeth; (d) no DMF permanent teeth; (e) water supply
contained 0.30 p. p. m. F prior to fluoridation.
422 FLUORIDATION OF WATER
If the Charlotte Negro children derive the same benefits from fluoridated
water as observed for white children at Aurora, 111., then 14 to 15 years after
continuous fluoridation at Charlotte we may expect that caries experience for
the 12- and 14-year-olds will be around 300 teeth per 100 children instead of
the present 725, or a probable reduction of around 55 percent. Even if there is
no increase in available services, the 29 teeth filled will represent corrections
of around 10 percent of the defects, as contrasted with the present 4 percent.
On the other hand, untreated dental caries will be reduced proportionately from
605 to around 231 teeth (allowing 40 teeth for extraction), or a reduction of
60 percent. Here then is the most striking expectation : a 60-percent reduction
in the number of teeth with untreated dental decay, without any increase in the
amount of available dental services.
NUMBER OF CARIES-FREE CHILDEB:^- INCREASES
Table 2 shows how fluoridated water has influenced the number of children
who have no dental decay. At Newburgh, N. Y., (10) after 60 months, there
has been a 170-percent increase in the number of 5- and 6-year-old children
who have no decay of the primary cuspids and first and second primary molars.
At Brantford, Ontario, Canada, (11) after 77 months, there has been an in-
crease of 208 percent in the number of children without decay of the primary and
permanent teeth for the 5 to 16 age group. At Sheboygan, Wis., (12) and (13)
after 65 months, kindergarten children without decay of the primary teeth in-
creased 134 percent, while 12- to 14-year-old children without decay of the per-
manent teeth increased 23 percent.
The significant increase in the number of children with no caries experience
of the primary and/or the permanent teeth in the early study areas should be
considered as of a preliminary nature, with the expectation that greater benefits
will be presented in subsequent reports.
PRIMARY (FOUNDATION) TEETH HAVE LESS DECAY
Table 3 represents a summary of some of the findings for the primary teeth.
While there may not be unanimity in the method of estimating caries experience,
it remains that where fluoridation has been in progress long enough the results
show definite reductions in dental caries. For the 5-year-olds, for example,
there were the following improvements: Grand Rapids (17) 38.9 percent less
caries, Newburgh (18) 59.9 percent less, Brantford (11) 54 percent less, She-
boygan (12) 53.7 percent less for the 5- to 6-year-olds, and 48 percent less for the
5-year-olds at Madison (16). The increases noted at Charlotte (19) are due to
our method of examination recording. Only the primary teeth present at the
time of the examination are accounted for, hence it may be assumed that with
fewer teeth lost because of extraction the number present at the time of the
later examination is greater. The findings for the primary teeth of the 5-year-
olds at Brantford after 77 months of fluoridation may very likely represent the
maximum improvement.
FLUORIDATION BENEFITS PERMANENT TEETH
Reports on the reduction of caries experience for the permanent teeth have
been collected in table 4. While the results are not in speciflc agreement, it is
impressive that all reports indicate definite reductions, with the youngest age
groups exhibiting the greatest benefits. Only the Brantford reports provide
specific information for a group of 6-year-olds who had been consumers of
fluoridated water since birth. Hence, most of the other reports are of a pre-
liminary nature. It should be noted here, too, that preliminary definitive results
will not be forthcoming until a group of 12- to 14-year-old children, who since
birth have been continuous residents in one of tlie fluoride study areas, can be
compared with a similar age group in a control city. To this we might add that
an equally interesting comparison will be with the findings for the 12-14 age group
in the study area during the prefluoridation period. Hence, the more extensive
comparisons will not be available until around 1959-60. If the older age groups
are to be included, and they should be, then more complete results will not be
available until some time in the 1960-80 period. There are some who want to
wait until that time before they give their approval, but in many instances they
will have given it long before that — for fluoridation is no longer a mere proposal.
These benefits noted here make fluoridation a fact.
FLUORIDATION OF WATER
423
Table 3. — Effects of fluoridated water on deciduous teeth
Place
Refer-
ence
Fluoridation
Started
Elapsed
(months)
Age
Caries experienced
Before
fluorida-
tion
After
fluorida-
tion
Percent,
reduc-
tion (R),
increase
(I)
Grand Rapids, Mich, (def) '.
Newburgh,N.Y.. (DF, per-
cent per 100 teeth) .3
Brantford, Ontario, Canada...
Sheboygan, Wis. (DEF)t.
Evanston, HI. (DEF)*
Charlotte, N. C:
Preschool, white.
Preschool, Negro.
(17)
(18)
(10)
(11)
(12)
(14)
(9)
January 1945.
May 1945
do-..
June 1945
March 1946....
February 1947.
54-60
48
April 1949.
do
Ottawa, Kans. (def)'
Madison, Wis. (def surfaces) .
(15)
(16)
1946
June 1948.
66
12-22
20-21
20-21
10
5-6
6
8
5
6
5
5.4
6.4
5.8
4.6
2 8
19U-i5
27.2
34.2
42.3
48.0
19U-46
37.0
19U-45
5.63
6.76
6.78
6.40
6.10
3.75
1945
4.80
1946
4.83
5.50
5.77
1949
4.09
4.45
3.84
3.78
September
1946
4.0
4.9
1947
8.14
1949-50
3.3
4.6
4.7
4.4
2.9
1949-50
10.9
18.6
30.3
38.9
1950-51
20.1
1951
2.59
3.44
4.39
4.24
4.87
3.17
1951
2.22
1948
5.08
5.41
6.20
1951
4.75
4.82
4.63
4.48
January
1951
3.6
4.3
1951
4.23
38.9
28.1
19.0
4.3
3.6
R 59.9
R 45.6
R 28.4
R 18.9
R 45.6
54.0
49.1
35.2
23.9
20.1
15.5
R 53.7
15.5
1.6
7.4
20.6
18.5
' def — decayed, extraction indicated, or filled.
2 7-year age group omitted; too few included in examinations.
3 DF— <iecayed or filled deciduous teeth.
* DMF or DEF (as used here)— decayed, extracted, or filled deciduous teeth.
5 Water supply contauied 0.30 p. p. m. F prior to fluoridation.
NOTE. — At Charlotte, N. C, only the deciduous teeth present at the time of examination
are accounted for, hence it is assumed that with fewer teeth lost due to extractions the
number present at the time of the later examination is greater.
For the 6-year age group there are the following reductions in dental caries
of the permanent teeth: Grand Rapids, (17) 59 percent; Newburgh, (18) 77.6
percent; Brantford, Ontario, (11) 73.2 percent; Evanston, (14) 49.8 percent;
Marshall, (21) 47 percent; and Ottawa, Kans., (15) 15 percent; Charlotte (19)
preschoolers — white, 25 percent, Negro, 12 percent. Dental caries reductions in
the other age groups in some study areas range from around 30 percent for the
10-year-olds to 6 to 25 percent for the 14-year-olds.
PROMOTION OF SUPPORT FOR FLVORIDATION
We have noted the impressive list of responsible health groups which endorse
fluoridation, the need for demonstrating the extent of the dental health problem,
and the extensive dental health improvements places where fluoridation pro-
grams have been in operation. All this information should be enough to chal-
lenge every dentist and physician in the Nation, every health officer, every health
worker and every community-conscious citizen, to bring fluoridation into being
in their home towns without delay.
In many instances the initiative for fluoridation comes through a dentist
or local dental group, but there is no reason why health ollicers, health educators
and other members of the community cannot initiate the promotion. In many
States, the junior chambers of commerce have made statewide fluoridation pro-
424
FLUORIDATION OF WATER
motion a major goal. Fluoridation programing is a prime activity of the North
Carolina Dental Society. At Charlotte, N. C, the Jaycees along with the
Charlotte Dental Society and the Charlotte Council of Parent-Teacher Associa-
tions were powerful factors in obtaining city council approval in June 1948.
After the local dental group has endorsed the program, support should be
sought from the medical group at a meeting of physicians alone, or a combined
meeting of physicians and dentists. In small communities it should be possible
for the dentists to give leadership and gain the broad support of many civic
organizations without any loss of time. When all these have passed resolutions
on behalf of fluoridation, at meetings where the subject has been presented, then
the matter should be brought to the board of health for their action. Finally, a
Table 4. — Effects of fluoridated water on permanent teeth
Place
Eef-
Fluoridation
Started
Elapsed
(months)
Age
DMF
Before
fluorida-
tion
After
fluorida-
tion
Grand Bapids, Mich.
(17)
January 1945.
Average
Southbury Training School,
Conn.
Newburgh, N. Y. (DMF per
100 erupted permanent
teeth).
Brantford, Ontario, Canada...
Sheboygan, Wis. (grades 4, 7,
8, and 9).
Marshall, Tex. (def, DMF
combined).
(20)
(18)
(10)
(11)
(13)
(21)
April 1945.
May 1945.
do..-..
June 1945.
March 1946.
May 1946...
Evanston, ni.
Lewiston, Idaho.
Charlotte, N. C:
Preschool, white.
Preschool, Negro.
Ottawa, Kans.«.
(14) February 1947.
(22) do
(23)
(19)
(15)
54-60
48
12-23
June 1947.
April 1949.
do
September 1946..
20-21
20-21
52
5-16
10
12
6-12
0.78
3.90
6.41
9.73
13.50
6.86
19U-i5
8.5
17.1
21.9
25.3
20.6
20.6
19U-i5
0.41
2.44
3.80
6.30
8.60
19i5
3.03
8.54
19i5
7.06
8.97
7.58
6.46
8.20
me
0.468
1.535
2.499
me
7.63
10.09
11.66
m7
1.4
2.6
3.7
1949
0.61
0.69
September
1946
0.41
0.70
1949-60
0.38
2.48
4.69
8.11
11.83
5.50
1949-50
1.9
9.9
15.9
18.8
13.9
1950-51
13.0
1951
0.11
1.07
2.57
4.31
6.41
1951
2.12
6.54
1950
3.69
3.76
5.48
6.68
6.70
1948
0.235
1.035
1.941
1949
6.82
8.57
10.87
1960
0.6
1.7
2.8
1951
0.46
0.61
January
1951
0.35
0.62
• Water supply contained 0.30 p. p. m. F. prior to fluoridation.
Source: City Health Department, Charlotte, N. C, fluoridation demonstration, April 24, 1950.
FLUORIDATION OF WATER
Table 5. — Seasonal variations in fiiioride levels
425
Month
Average air temperature
Since 1878 1945-49
Period beginning (nearest Sat-
urday niglit to ttie date)
P. p. m. F.
(deviation,
plus or
minus 0.10)
January. .-
February.
Marcti
AprU.
May
June
July .-
August
September
October. --
November
December.
41.2
43.9
50.4
59.8
68.9
75.5
78.4
77.1
71.5
61.7
50.6
43.0
44.1
45.4
54.6
62.6
69.0
77.4
79.1
77.5
72.3
63.0
52.9
44.4
Jan. 1..
Feb. 1..
Mar. 15
Apr. 15.
May 1.
June 15.
July 1..
Aug. 1.
Sept. 1.
Oct. I.-
Nov. 1.
Dec. 1-
1.10
1.10
1.05
0.95
0.80
0.70
0.60
0.65
0.75
0.85
0.95
1.05
delejration representing the various professional and lay organizations endorsing
the measure should present the proposal to the governing body of the community
for its approval.
From the very beginning and all through the planning, the water-plant opera-
tor should serve as a consultant to the principal organization or committee pro-
moting fluoridation.
Every meeting on fluoridation and every endorsement or resolution favoring
the proposal should be widely publicized in the press and on the radio. A series
of prepared articles should be published in the press to enlighten the people
in the community.
When an outstanding speaker is brought in for a big meeting, an interview on
the radio and with the press should be arranged. At these meetings, key
people from all organizations should be invited guests for the occasion. The
press sliould be invited to every affair.
Before the proposal is presented to the governing body of the community,
approximate initial-cost figures and all subsequent annual costs should be estab-
lished, with some estimation of the per capita cost initially and per annum
thereafter.
Because of the large number of approved programs in operation and because
of the benefits reported from the study areas, promotion of fluoridation as a
rule will not encounter objections from anyone. However, there are some
diehard opponents, who may turn up in your town. They will accuse the pro-
ponents of every conceivable form of misrepresentation. Occasionally, these
may poison the minds of enough people to forestall early development of a
fluoridation program. Be patient but firm with them, for in many instances
their arguments will be the source of their own defeat.
THE COST OF FLTTORIDATION
The initial cost will cover the fluoride feeder, accessories, installation, pos-
sibly some laboratory equipment, reagents and the chemical. These will vary
with the size of the town. However, if the cost of the capital equipment is
amortized over a period of 20 years, the per capita cost per year might approxi-
mate 6 to 12 cents, depending on the chemical that can be used. Sodium silico-
fluoride will be less expensive than sodium fluoride, but its use will be limited
to dry feed installations. Much of this will be included in the United States
Public Health Service film. Drop in a Bucket, which Dr. Carl L. Sebelius has
brought to this symposium for presentation at the conclusion of this paper.
FLTJOEIDE LEVELS
In the Southern States, there should be no small amount of interest in the
fluoride levels to be prescribed. The adjustment of fluoride levels, that is the
amount of fluoride to be added at various periods of the year, will be based on
climatological conditions. In Georgia, Dean (24) examined 12-, 13-, and 14-
year-old children at Brunswick (water F. 0.50 p. p. m.) and Moultrie (water
F. 0.70 p. p. m.) and noted that there were incidencies of the mildest type of
dental fluorosis, 12.6 and 9 percent for Brunswick and Moultrie respectively
426 FLUORIDATION OF WATER
(mean annual temperature 68° F.). He indicated that such incidences would
normally be associated with domestic water having approximately 1 part per
million F., under climatological conditions prevailing in the Chicago area, with
its mean annual temperature of about 49 degrees Fahrenheit. This "very
mild" fluorosis has been described by Dean (25) as "small opaque paper-white
areas scattered irregularly, involving less than 25 percent of the tooth surface"
and of no esthetic consequence.
SEASONAL FLUORIDE VARIATIONS AT CHARLOTTE
At Charlotte, N. C, with a mean annual temperature of GO to 62 degrees
Fahrenheit, it was concluded that fluoride levels which were satisfactory in
more northerly places would not necessarily hold for us. When we were in the
discussion stage in 1947, Dr. Finn strongly endorsed a fluoridation program
at Charlotte, noting that what might apply elsewhere would not necessarily be
satisfactory for us. Here then was practical confirmation of his observation.
It was obvious that more water was consumed (hence more fluoride ingested)
over a longer period at Charlotte than at places in the northern tier of States.
The speaker and R. S. Phillips, superintendent of plants of the Charlotte Water
Departmbent, examined many water consumption figures which might serve as an
index of seasonal variations of water consumption for drinking purposes (26).
Figures for bottlers of soft drinks and the monthly sales variations of a bottler
of spring water were studied and plotted for a 12-month period and it was noted
that the curves paralleled the curve for the mean monthly air temperature, as
illustrated in figure 2. With this as a guide, a schedule of season variations in
fluoride levels was prescribed, table 5, ranging from a low of 0.60 parts of fluorine
per million parts of water in July to a high of 1.10 p. p. m. F during January
and February, providing an average fluoride level for the year at slightly less
than 0.90 p. p. in. The schedule has been in operation since March 1950 without
any difficulty of any consequence.
FLUORIDE LEVELS IN FLORIDA
It is interesting to note that while most State regulations allow a maximum of
1.50 p. p. m. F, Florida (27) has established the following limitations: From
November through April, preferably 0.8 to 1.10 p. p. m. F, not to exceed the
latter. May through October 0.60 to 0.80 p. p. m. F.
FLUOKIDATION NOT 100 PERCENT DENTAL CARIES PREVENTIVE
It must be repeatedly emphasized that fluoridation may prevent only as much
as 50 to 60 percent of dental caries. Unless there is a sustained program of
dental-health education, there is a great likelihood that over the years many
people will deA-elop a false sense of dental-health security. For this reason, we
must continue to stress (1) the need for a program of early and regular dental
care to prevent tooth loss, (2) moderation in the consumption of carbohydrates,
and (3) brushing or rinsing the teeth immediately after eating.
FLUOEIDATION IMPLICATIONS FOR THE RURAL AREAS
In most rural areas there are no community water systems, for rural people
have their own wells, or other sources of water. For these people, numbering
some 55 millions, it may be possible to develop methods for providing fluoridated
water for the infants and children ; for example, a small tablet could be prepared
which when dropped into a quart of water would provide the desired fluoride
concentration for a particular area, for a particular water supply, and for a
particular season.
TOPICAL FLUORIDE PROGRAMS MUST GROW
For the present there must be a broad development of programs for the topical
application of fluorides. For example, in North Carolina around 73 percent of
the population are not served by community water-distribution systems. To
provide topical fluoride applications for children in such a large population group
it would be necessary to have a considerable increase in the available number
of dental hygienists. It is not likely that these will be forthcoming in the near
future unless some broad dental hygienist training program is set up on a local
or regional basis, with liberal scholarships offered to those who will work at
FLUORIDATION OF WATER 427
least 1 year in the topical fluoridation program (under State or local health
department direction) in return for every year of training. There should be
more schools of dental hygiene established and this is especially important for
training Negro girls.
SUMMARY
In summary then, we have noted the following :
1. Water fluoridation as a measure for the mass partial prevention of dental
caries is now endorsed by the principal agencies and organizations concerned
with health.
2. In March 1952, fluoridation is in operation, approved or receiving serious
consideration in 654 places in 45 States for an estimated population of some
38,651,195 people.
3. The 200 places in operation and the 250 places where fluoridation has been
approved represent a total population of some 20 million people, but only 3 per-
cent of the 15,000 communities that have fluoride-deficient water supplies.
4. Dental examinations are basic to demonstrating the dental health problem.
5. Charlotte white and Negro 12 and 14 year olds are compared with the same
age group at Aurora.
6. Reports from the study areas show considerable increases in the number
of children with no dental caries, or with reduced caries experiences of the pri-
mary and permanent teeth.
7. Promotion of a fluoridation program has been discussed.
8. Fluoride levels may be lower in the Southern States and may be varied
according to the season.
9. It has been noted that water fluoridation is not a 100 percent dental-caries
preventive.
10. For the 55 million people who are not served by community water supplies,
there should be programs for the topical application of fluorides.
11. There is serious need for more schools of dental hygiene, especially for
Negro girls. A liberal scholarship program has been suggested.
References
1. Yolker, J. F. : Effect of fluorine on solubility of enamel and dentin. Proc.
Soc. Exper. Biol. & Med., 42 : 725, 1939.
Volker, J. F., Sognnaes, R. F., and Bibby, B. G. : Studies on distribution of
radioactive fluoride in the bones and teeth of experimental animals. Am. Jnl.
Phys. 132:707 (1941).
Volker, J. F., Hodge, H. C, Wilson, H. J., and Van Voorhis, S. N. : The absorp-
tion of fluorides by enamel, dentin, bone and hydroxyapatite as shown by radio-
active isotope. Jnl. Biol. Chem., 134 : 543 (1940) .
Volker, J. F. : Observations on the absorption of fluoride by the enamel. Jnl.
Dent. : Res. 22 : 201 (1943).
2. Hodge, H. C, and Finn, S. B. : Reduction in experimental rat caries by
fluorine. Proc. Soc. Exper. Biol. & Med., 42: 318 (October) 1939.
3. Moulton, F. R., ed. : Fluorine and Dental Health, Pub. No. 19, Amer. Assoc.
Adv. Science, Lancaster, Science Press, 1942.
4. Moulton. F. R., ed. : Dental Caries and Fluorine, Amer. Assoc. Adv. Science,
Lancaster, Science Press, 1946.
5. Hutton, W. L., Health OflScer, Brant County Health Unit, Brantford, On-
tario, Canada. Personal communication.
6. Knutson, J. W. : Current status of the water fluoridation program. Pre-
sented at the 50th Annual Conf. of the Assn. of State and Territorial Health
Officers, Nov. 26-29, 1941, Washington, D. C.
7. Dean, H. T., Jay, P. Arnold, F. A., Jr., McClure, E. J., and Elvove, E. :
Domestic water and dental caries. Pub. Health Rep. 54:862 (May 26) 1939.
8. Dean. H. T., Jay, P., Arnold, F. A.. Jr.. and Elvove, E. : Domestic water and
dental caries, II. Studv of 2,832 12- to 14-year-old white children. Pub. Hlth.
Rep. 56: 761 (April 11) 1941.
9. Unpublished data of the Charlotte (N. C.) Fluoridation Demonstration.
10. Ast, D. B.. Director, Bureau of Dental Health, N. Y. State Health Depart-
ment Report of 1944-51 comparisons.
11. Hutton, W. L., Medical Health Officer, and Linscott, B. W., Dental Health
Officer, Brant County Health Unit, Brantford, Ontario, Canada. Report of 1944-
51 comparisons.
48391—54 28
428 FLUORIDATION OF WATER
12. Bull, F. A., Dental Director, Wisconsin State Board of Health. Sheboygan
survey — Deciduous teeth. October 8, 1951.
13. Bull, F. A., Dental Director, Wisconsin State Board of Health, Sheboygan
survey — Permanent teeth. November 5, 1951.
14. Hill, I. N, Blayney, J. R., and Wolf, W. : The Evanston dental caries study.
Vi. A comparison of the prefluoride with the postfluoride caries experience of
6-, 7-, and 7-year-old children in the study area (Evanston, 111). Jnl. Dent. Res.
29:534 (Aug.) 1950.
15. Bellinger, W. R., Director, Division of Dental Hygiene, Kansas State Board
of Health. Prelim. Report on Ottawa, Kansas, Caries-Fluoridation Project.
Dec. 1951.
16. Frisch, J. G., Chairman, Wisconsin Dental Society Fluorine Study Com-
mittee. Report on Madison, Wisconsin, after SV2 years of fluoridation with
hydrofluoric acid. Dane County Dental Society and the Madison Department of
Health. December 1951.
17. Dean, H. T., Arnold, F. S., Jr., Jay, P., and Knutson, J. W. : Studies on
mass control of dental caries through fluoridation of the public water supply.
Pub. Health Rep. 65 : 1403 (October 27) 1950.
18. Ast, D. B., Finn, S. B., and Chase, H. C. : Newburgh-Kingston caries study
III. Further analysis of dental flndings including the permanent and deciduous
dentitions after four years of water fluoridation. Jnl. Am. Dent. Assn. 42 : 188
(Feb.) 1951.
19. Stadt, Z. M. : The Charlotte Fluoridation Demonstration. Jnl. North Caro-
lina Dental Society. 85 : 58 (Jan.) 1952.
20. Erlenbach, F. M., and Tracy^ E. T. : Control of Dental Caries by fluoridation
of a water supply. Second year. Conn. Health Bull. (Sept. 1949 reprint).
21. Taylor, E., Dental Director, Texas State Bd. of Health. 1946-51 com-
parison of dental flndings.
22. Hill, I. N., Blayney, J. R., and Wolf, W. : The Evanston dental caries study
VII. The effect of artiflcially fluoridated water on dental caries experience of
12-, 13-, and 14-year-old school children. Jul. Dent. Res. 80:670 (Oct.) 1951.
23. Pelton, W. J. : Water fluoridation benefits at Lewiston, Idaho. American
Dental Association Council on Dental Health Newsletter, Vol. 6, No. 7 (July 7)
1950.
24. Dean, H. T. : The advancement of fluoridation. Jnl. Am. Water Works
Assn. 48:17 (Jan.) 1951.
25. Dean, H. T. : Endemic dental fluorosis or mottled enamel. Jnl. Am. Dent
Assoc. 30 : 1278 (Aug.) 1943.
26. Stadt, Z. M., and Phillips, R. S. Unpublished report.
27. DeCamp, F. H., Dental Director, Florida State Board of Health. Personal
communication.
[Reprinted from Journal of the National Medical Association, September 1953, vol. 45,
No. 5, pp. 350-353]
Fluoridation in the Prevention of Dental Caries ^
Clifton O. Dummett, D. D. S., Chief, Dental Service, Veterans' Administration
Hospital, Tuskegee, Ala.
It is signiflcant and appi'oprlate to begin this discussion on fluoridation
with a statement by Col. John R. Wood, who is chairman of the Medical Re-
search and Development Board of the Office of the Army Surgeon General.
He told the American Pharmaceutical Manufacturers Association, "Badly
needed is more research to find ways of preventing the enormous waste of
human teeth. More than 40 percent of men entering the services in World
War II needed immediate treatment to save their teeth about to be lost, and
one-third of them needed treatment for toothaches. Five percent need new
teeth to have enough to chew with. Even to date, our troops are losing col-
lectively well over a million teeth per year. The cost of this care, at the most
conservative civilian rate, exceeds $18 million a year. Yet, only about a
million dollars a year are being spent on dental research, only part of that on
methods of halting this waste." This statement by a phy.sician discussing the
topic of dental research to a group of pharmacists is illustrative of the rela-
tionships that exist between these professions.
1 Presented to a ioint session of the Indiana State Medical, Dental, and Pharmaceutical
Associations, May 20, 1953. Gary, Ind.
Published with the permission of the Chief Medical Director, Veterans' Administration,
who assumes no responsibility for the opinions expressed by the author.
FLUORIDATION OF WATER 429
There is among the American people, a great need for more adequate dental
services. This need has become recognized because much greater emphasis
is being placed on the necessitj' and importance of visiting dentists regularly.
The inability to fultill a large portion of this need has occupied the attention
of members of the dental profession. The dearth of personnel and facilities
for training are conditions of which everyone is aware. It has become neces-
sary, therefore, to attack the problem on limited fronts. Today when a dental
program is established in a community, it is common for the dentist to limit
his services almost entirely to emergency dental care. Such a program is
certainly not satisfactory.
Similar limitations occur in dental public health programs. There is a tre-
mendous need for more adequate dental care for children. An apathetic atti-
tude exists on the part of many people toward dental diseases insofar as they
affect children. Such a commonplace acceptance of dental disease in chil-
dren constitutes a real danger and an obstacle to progress in dental public
health. Often heard are statements that the problem is too great to attack
or that dental disease lacks in public appeal.
Dental caries is the first disease that has come in for a concerted attack by
dental researchers, who have been responsible for the accumulation of much
important information on the topic of fluoridation.
It is well established that certain preventive dental procedures are known
to reduce the incidence of dental caries if they are applied at an early period.
Some control of dental caries can be accomplished by the restricted use of re-
fined carbohydrates, the use of topically applied fluorides to the teeth, the
controlled fluoridation of municipal water supplies and the proper use of the
toothbrush especially following the consumption of fermentable sugars. The
use of fluorides, especially the fluoridation of public water supplies is rapidly
developing into a comprehensive nationwide movement. The division of dental
public health of the United States Public Health Service considers the pro-
motion of controlled fluoridation, its priority one project. This is also true of
the divisions of dental health of State health departments of this country as
well as dental society groups. The committees of workshop, public relations,
and dental health of the Tennessee State Dental Association recently conducted
a workshop which had as its theme, "Help yourself to water fluoridation."
The Institute of Public Health which was presented by the Dental Service of
the Veterans' Administration Hospital in Tuskegee, Ala., in March 1952, had
as one of its objectives, the presentation of modern scientific information about
water fluoridation. Basically, this institute stressed the fact that all individu-
als interested in dental health should think, plan, and work together toward
the goal of better dental and general health. The controlled fluoridation of
water is a start in the right direction.
If there is to be a solution to the dental caries problem, it will come through
prevention. If prevention is to progress in eliminating the vast reservoir of
untreated dental caries for future generations, preventive means must be ap-
plied to large segments of the population. Discouraging the sale and limiting
the use of sugars, though effective in reducing caries, are not procedures that
are readily followed. Human beings are not easily dissuaded from the use of
refined carbohydrates. It would seem that the best means of reaching the
entire population equitably is through a community water supply. "Water is
a commodity that is consumed consistently by all persons.
It is highly advisable that any agent used for the purpose of reducing dental
decay for the entire population should have five important requisites: d) it
must be of unquestionable value, (2) it must be relatively inexpensive, (3) it
must be safe to use, (4) it must be easily utilized on a population basis, and
(.5) it must require little or no effort on the part of the individual benefited.
It would appear that water fluoridation or the treatment of a communal water
supply meets the requirements of a preventive agent most adequately. No-
where in medicine, pharmacy, or dentistry has a preventive agent had such
a vast amount of irrefutable evidence to recommend it and so little reliable
confirmed evidence against it. The large amount of epidemiological and ex-
perimental evidence that has gone into the establishment of the fluorine-
caries hypothesis is most impressive.
As early as ISfiT. INIagitot suggested that fluorine was associated in some
way with the integrity of the tooth. In 1892. Sir Crichton Brown writing in
the British medical journal. Lancet, indicated that teeth contained more fluo-
rine than any other tissue in the body and that the fluorine was there to pre-
430 FLUORIDATION OF WATER
veut dental decay. He suggested that foods rich iu this element should be
incorporated in the diet of children for that purpose. From 1908 to 1916, Drs.
Black and McKay thoroughly studied the pathological condition of the teeth
endemic among those reared in certain limited areas of southwestern United
States. Among these individuals the teeth were poorly formed, stained, and
pitted. To this disfiguring disease, thej^ applied the term "mottled enamel."
They observed that "mottled enamel" could be acquired only if persons resided
in those areas during the period of tooth formation. Once acquired, it re-
mained for life. They further observed that people moving into these areas
after their teeth were formed did not acquire this disease. They established
the fact that the cause of mottled enamel was in some way waterborne. In
1931 through chemical analysis of water and through animal experiments, it
was discovered that mottled enamel was caused by excessive amounts of
fluorine in the drinking water supply. In 193S, Dean and his associates re-
examined these endemic areas of southwestern United States and other areas
in the Midwest where fluorosis was endemic. They found that the severity
of the fluorosis was directly proportional to the fluorine content of the water
consmned. Esthetically significant, mottling occurred only in individuals con-
suming over 1.5 parts per million of fluorine. The epidemiological studies of
Dean and his associates further indicated that individuals consuming water
containing one or more parts per million of fluorine had approximately 60
percent less dental caries than individuals in neighboring communities where
fluorine-free water was consumed. They also made the important deduction
that the reduction in dental caries was not inversely proportional to the fluo-
rine content of the water supply. As a matter of fact there was just as great
a reduction when the water contained 1 part per million of fluorine as wh^n
it contained 14 parts per million, and furthermore, one did not get disfiguring
fluorosis. These observations by Dean and others from difl'erent areas of
the world received additional confirmation from animal experiments and from
chemical analyses of the fiuorine content of sound and carious teeth. Recent
studies indicate tliat this resistance to caries once acquired persists throughout
life. There are actually 8 million persons in the United States consuming
natural water containing 1 part per million of fluorine or over.
The question soon presented itself as to why could not fluorine be added
artificially to the water supplies in areas where fiuorides were deficient. In
1938, Cox, speaking before the Pennsylvania Waterworks Association, sug-
gested artificial fluoridation. By 194.") a number of communities in the United
States were fiuoridating their water on a demonstration basis.
One of the community demonstration projects was the Newburgh-Kingston
study which was initiated in 1944 by the New York State Health Department.
A principal investigator in this project was Dr. Sidney Finn, now a faculty mem-
ber of the University of Alabama's Dental School and consultant to the Dental
Service of the Veterans' Administration Hospital Hospital in Tuskegee. For
this demonstration project, Newburgh, N. Y., 60 miles above New York City,
had its water fiuoridated with 1.2 parts per million of sodium fiuoride on May
2, 194.J. Kingston, a similar sized city 30 miles above Newburgh, continued to
drink fluorine-free water and served as a control. Annual dental examinations
were made on the entire school populations of over 300 children in each city.
At the end of 4 years, laboratory, clinical, and roentgenographic examinations
all showed a markedly reduced caries activity in the schoolchildren of Newburgh.
Medical studies were carried on at the same time to determine whether or not
there were toxic systemic effects. Complete physical examinations consisting
of height and weight measurements, examination of body organs, blood counts
and hemoglobin, urinalysis, roentgenograms of long bones and ossiflcation centers,
visual acuity tests and audiometric examinations were made on the children
in Newburgh and Kingston. After 7 years of fluoridation, no difference has been
noted between the children of the 2 cities.
There are several fluoride compounds available for water fluoridation. Among
these are sodium fluoride, hydrofluoric acid and sodiima silicofluoride. For
small cities and towns sodium fluoride is recommended. Because of its solu-
bility it is readily adaptable for use in inexpensive feeding equipment and the
chemical is available in moderately abundant supply. It is a white crystalline
salt which in commercial form is dyed nile green or light blue to distinguish
it from other salts that ai-e white. It is a very toxic substance, four or five
grams, or a tablespoonful being a fatal dose. Yet in quantities of one part per
million of fiuoride it is perfectly safe to use in communal water supplies. One
FLUORIDATION OF WATER 431
part per million is a very small amount. If one drinks on the average of 2
quarts of water a day containins: 1 i)art per million of fluorine, he consumes
rou.ffhly 4 milligrams of sodium tluorido. Since 4 grams or one tablespoonful
is a lethal dose, to get this amount, one would have to consume one thousand
times the amount of water he normally drinks in a day at one time, or 500
gallons of water at one sitting. One quarter of a gram of sodium fluoride
when swallowed at one time may produce nausea and vomiting. In terms of
fluoridated water, instead of the customary 2 quarts a day, one would have to
drink 12."> times that much or 63 gallons at one time. Those opposing fluorida-
tion insist that fluoridated water might produce crippling fluorosis. This is
observed only in areas where the residents consume at least 20 milligrams of
fluoride a day over a period of 10 to 20 years. In the case of water fluorida-
tion at 1 part per million of fluorine, instead of 2 quarts of water a day one
would have to drink at least 2V2 gallons of water daily over a 10 to 20 year
period, which is again over 10 times the average daily water consumption.
Hodge, of the University of Rochester, has said that it is impossible to imagine
any set of circumstances in which the fluoride content might become sufficient
to bring about chronic high-grade fluorosis.
There are many instances that can be cited where a chemical may be lethal
in large amounts and beneficial in small amounts. Although iodine is a poison,
small amounts of it are essential for the maintenance of life. Chlorine is used
to kill bacteria in water supplies. It is common knowledge that it was used
as a poison gas in the First World War. Even common table salt if consumed
in large quantities may produce death. Sodium fluoride is another example of
a chemical which might be toxic in large quantities, but is beneficial when used
in small quantities.
The evidence corroborating dental health benefits derived from waterborne
fluorides is so overwhelmingly abundant that the measure is now endorsed
by important international, national and local groups concerned with health.
These organizations and agencies include the interassociation committee which
is composed of the American Dental Association, the American Medical Asso-
ciation, the American Hospital Association, the American Nurses Association,
the American Public Health Association and the American Welfare Association.
There are several other endorsers of fluoridation : among them are the Federa-
tion Dentaire Internationale, the National Research Council, the United States
Public Health Service, the State and Territorial Health Officers, the State and
Territorial Dental Health Directors, the American Association of Public Health
Dentists, a large majority of State dental societies, many State health depart-
ments, an increasing number of State medical societies and hundreds of county
dental and medical groups, boards of health, local professional organizations
and lay organizations such as the Jaycees, Rotarians, Lions, and Kiwanis.
The impressive list of reponsible health groups which have endorsed fluori-
dation should be enough to challenge every dentist, physician, pharmacist, nurse,
health officer, health worker, and every citizen to foster fluoridation in needed
areas. In many instances the initiative of fluoridation comes through a dentist
or local dental group, but there is no reason why health officers, health educators,
physicians, or other members of the professions and communities cannot initiate
the promotion. After the local dental group has endorsed the program, support
should be sought from the medical group at a meeting of physicians alone or a
combined meeting of physicians and dentists. In small communities it should be
possible for the dentists to give leadership, and gain the broad support of many
civic organizations without any loss of time. When all these groups have passed
resolutions on behalf of fluoridation at meetings where the subject has been
presented, then the matter should be brought to the board of health for its
action. Finally, a delegation representing the various professional and lay
organizations endorsing the measure should present the proposal to the govern-
ing body of the community for its approval. From the very beginning and all
through the planning steps, the water plant operator should serve as a con-
sultant to the principal organization or committee promoting fluoridation.
Every meeting on fluoridation and every endorsement or resolution favoring the
proposal should be widely publicized in the press and on the radio. A series
of prepared articles should be published in the newspapers to enlighten the
people of the community. Approximate initial costs and all subsequent annual
costs should be established and there should be some estimation of the per
capita cost initially and per annum thereafter. Because of the large number
of approved programs in operation and because of the benefits reported from
the study areas, promotion of fluoridation as a rule will not encounter objections
432 FLUORIDATION OF WATER
from anyone. However, there are some tenacious opponents who may oppose
it. They will accuse the proponents of every conceivable form of misrepresenta-
tion. Occasionally these persons may poison the minds of a sufficiently large
number of people, so that the early development of a fluoridation program
will be forestalled. In such cases it is absolutely essential to be patient but
firm, for in many instances their arguments will be the source of their own
defeat.
It must be repeatedly emphasized that fluoridation may prevent only as much
as 50 to GO percent of dental caries. It is not 100 percent dental caries pre-
ventive. Unless there is a sustained program of dental health education, there
is a great likelihood that over the years, people may develop a false sense of
dental health security. For this reason, it is essential for dentists and physicians
to continue to stress the need for a program of early, regular dental care to
prevent tooth loss. The need for moderation in the consumption of carbohy-
drates, and the necessity for brushing or rinsing the teeth immediately after
eating are very important additional essentials.
The New Jersey State Dental Society,
May IS, 1954.
Hon. Chables A. Wolveeton,
Chairman, Interstate and Foreign Commerce Committee,
House of Representatives, Washington, D. C.
Deak Sir: I am writing at this time in connection with the scheduled hearings
on the Wier bill (H. R. 2341) which I understand are to be held on May 25, 26,
and 27. As chairman of the council on fluoridation of the New Jersey State
Dental Society, I am, naturally, most interested in the disposition of this bill.
I have been following the reports in dental and medical literature on the
investigation of the possible harmful effects of fluoridation on health, and in
the many years of review I find that there is no authenticated indication that
any effects other than a sharp decrease in the amount of dental decay results
from the introduction of the recommended amount of fluoride ion to drinking
water.
Anyone who takes the trouble to review the literature on the subject cannot
help but be impressed by the pains to which these investigators have gone to
exhaust all the possibilities of any ill effects, not only on the general health of
the individual, but of any possible detrimental effect on any industrial process
or product. The conclusions are uniformly the same, and have been reconfirmed
over and over again. In addition to all this work done in areas where the fluoride
ion has ben artificially added to the drinking water, we have the unique situation
where statistics are available on the health, birth rate and death rate, incidence
of various diseases, etc. in those areas of our country where the fluoride ion
exists naturally in the drinking water, and where some 3i/^ million persons have
been ingesting this water all their lives. Medical societies have reported that
in these areas where fluoride has been present for generations the rate of birth,
death, sickness, bone fracture, etc., is approximately the same as in any other
part of the country. There are those who maintain that such may be the case
in naturally fluoridated areas but they imply that artificially added fluoride ion
will have a totally different effect. It is a well-known truism of chemistry that
an ion of fluoride (or of any element) is uniformly identical, regardless of source.
In this connection I quote from A. P. Black, head of the department of chem-
istry. University of Florida, Gainesville : "There are no physical or chemical
differences of any kind between fluorides naturally present in the water and
fluorides being added in any forms presently being used in this country * * ♦
these ions are identical, and it is not logical to suppose that the same ions in
water would produce different effects, depending whether they were naturally
present or have been added * * *. The effects of natural fluorides and added
fluorides in reducing dental caries are identical for the same concentration. This
has been conclusively shown by comparison of the Grand Rapids and Newburgh
data with data from the same age groups at Aurora, 111., where fluorides are
naturally present. The same conclusions have been reached in numerous othpr
studies conducted throughout the country."
The overwhelming weight of evidence leads us to but one conclusion : that
there is not a shred of scientific evidence that sodium fluoride in drinking water
FLUORIDATION OF WATER 433
at the recommended concentration of one part per million (1/10,000 of 1 percent)
has any harm|ul effect upon the health of the people.
The fluoridation of water has been attacked by some groups on various grounds
ranging literally from the ridiculous (e. g., a Communist plot to poison the
populace) to the sublime (e. g., "medication" of water may be incompatible
with religious beliefs). Some of the opponents are sincere, some merely publicity
seekers. In any case, however, every attempt has been made by men of authority
and stature in the field of science to answer satisfactorily any objections raised,
however remote they might be. It is only for this reason that such reputable
and authoritative groups such as the United States Public Health Service, the
American Dental Association, the American Medical Association, the National
Research Council, the American Public Health Association, the State and Ter-
ritorial Health Officers Association, the American Association of Public Health
Dentists, the American Water Works Association, plus hundreds of State and
community health and civic groups and university departments have all gone
on record as officially endorsing favorable policies on fluoridation. It seems
fairly obvious that not a single one of these groups, no less all of them, would
have taken a stand on such an issue without first investigating thoroughly and
find no reasonable doubt as to its merits and safety.
As to the need for such a program of fluoridating water where feasible, the
results of dental examinations on prospective draftees of World War II indicates
in what deplorable condition the teeth of our Nation is at present. When we
consider that 1 out of every 9 draftees didn't meet minimum dental requirements
before they were lowered almost to the point of elimination entirely, and this
condition in a nation which can boast of the quality of its dental service and
standard of living, we begin to get a perspective on the subject. Add to that the
statistical fact that indicates that dental defects are occuring at a rate six times
faster than they are being repaired, and you begin to see in what direction we
are heading. We simply must have some simple means, available to all and at
insignificant cost, whereby this destructive disease, dental caries, can be at least
partially held in check. This we know can be brought about by fluoridation
in controlled manner of public water supplies, where a reduction in dental decay
up to about 65 percent can be expected. Then, perhaps, in another generation,
we can boast of a nation which has this condition under control. In this con-
nection, defeat of the Wier bill (H. R. 2341) is imperative in the public interest.
Very truly yours,
Francis Lehk, D. D. S.,
Chairman, Council on Fluoridation, Neiv Jersey Dental Society.
State op New Jersey,
Department op Health,
Trenton, May 18, 195Jf.
Hon. Charles A. Wolverton,
House of Representatives, Washington, D. C.
My Dear Mr. Wolverton : It has come to my attention that you are serving
as chairman of the Interstate and Foreign Commerce Committee which is to
hold hearings May 25, 26, and 27 on the Wier bill, designated as H. R. 2341.
This bill introduced by Congressman Wier prohibits the treatment of any public
water sui)ply with any fluoride compound.
As chief of the Bureau of Dental Health, New Jersey State Department of
Health, I wish to express my strong opposition to the enactment of this bill.
A few of my reasons for this statement are as follows :
1. Coming from New Jersey yourself. Congressman, I am certain you know
of the advantages in dental health to our children in Gloucester and Salem Coun-
ties. A 300-square-mile area in these counties contains fluorides at a concentra-
tion of 1 to 2.4 parts per million. By survey of the children in Woodstown. N. J.,
and other communities in this area, and in 26 nonfluoride areas in New Jersey,
we have proven that dental decay rates are 60 to 65 percent less in the fluoride
areas. I am enclosing technical reports which show the findings relating to the
benefits of fluorides in drinking water in our own New Jersey. We are indeed
fortunate in New Jersey to have such a fluoride area that we may compare
statistically the DMF (decayed, missing, and filling) rates. These same benefits
can be attested to by every practicing dentist in these fluoride areas of Wood-
bury, Pitman, Glassboro, Woodstown, etc.
434 FLUORIDATION OF WATER
2. We have on file resolutions favoring fluoridation by :
(a) Each of the 12 component dental societies comprising the New Jersey
State Dental Society.
(&) Each of the 21 county medical societies.
(c) The New Jersey State Dental Society.
(d) The New Jersey State Medical Society.
(e) The American 13ental Association.
(/) The American Medical Association.
(g) The New Jersey State Department of Health.
(h) The United States Public Health Service.
(i) Many others such as National Parent-Teachers Association, American
Legion, etc.
3. Twenty-six communities in New Jersey are now fluoridating their water
supplies.
4. In the last November election, Perth Amboy placed this question before the
voters, and the vote was 3 to 1 in favor of fluoridation. Perth Amboy comprised
the 26th community to initiate fluoridation.
5. Atlantic City has endorsed fluoridation, moneys are in the budget for this
item and we are expecting this health resort to start fluoridating its water
supply in a month or two.
6. A permit has been granted Freehold, N. J.
Research studies have led to the endorsement of fluoridation by the American
Dental Association, official spokesman for more than 70,000 dentists. The
American Medical Association also has adopted a statement on the desirability
and safety of fluoridation. In fact hundreds of National, State, and community
health and civic groups have adopted favorable policies on fluoridation. In New
Jersey this pattern has not changed. This preventive public health measure
must not be contravened — thereby denying our children, and posterity in gen-
eral, the benefits of fluoride in drinking water. Corrective services alone cannot
meet the ever-present high rate of dental decay and the mounting accumulation
of dental defects. A wider use of preventive measures, such as fluoridation, is
the most realistic and economic approach. Fluoridation is safe and effective.
Years of study and research are required before a health measure, such as
fluoridation, can be recommended with safety. The dental benefits of fluorida-
tion have been thoroughly explored. In addition, studies have been conducted
among people who have lived continuously in areas where drinking water nat-
urally contains high concentrations of fluorides. The research work has been
painstaking, yet no scientist has been able to find any harmful effects from
fluorides in the amount recommended for protection against dental decay.
With all the evidence favoring the fluoridation of public water supplies, may
I urgently request of you, Congressman Wolverton, to assist all future genera-
tions of New Jersey citizens to enjoy the same protection against dental decay
as is naturally available to Gloucester and Salem County residents .
I urgently ask your assistance in defeating bill H. R. 2341.
Sincerely yours,
Eael G. Ludlam, D. D. S., M. P. H.,
Chief, Bureau of Dental Health.
The Flourination of Communal Water Supplies
By J. M. WisAN, D. D. S., Chief, Division of Dental Health,
Neiv Jersey State Department of Health
Presented before New Jersey Section, American Water Works Association, and
South Jersey Water Superintendents, Atlantic City, N. J., November 7, 1947.
The division of dental health of the New Jersey State Department of Health
has recently completed a study comparing dental conditions among New Jersey
children in 1946-47 with conditions found in 1933-34. The findings indicated
that dental caries among children appears to be on the increase in New Jersey.
Almost twice as many fillings were inserted for children of school age in 1946-47,
than had been placed in 1933-34. (1) In spite of the fact that New Jersey den-
tists ai'e performing more denistry for children, no gains have been made because
of the increasing dental caries rate. Stating it in other words, parents are spend-
ing more for dental care without appreciably reducing the rate of dental decay
among children. Preventive measures are required — procedures which will lower
the basic caries rate substantially.
FLUORIDATION OF WATER 435
Since flnorination of communal water supplies has been so frequently men-
tioned as a means of preventing dental decay, a resume of the investigations of
the relation of fluorides to teeth should be of interest. The earliest reference to
the mottling of teeth appeared in a short communication to the Dental Cosmos
in 1902 from Napls, Italy. In 1908, the Colorado Dental Society undertook an
investigation of what was then known as "Colorado brown stain" of the teeth.
It was generally recognized in Colorado Springs that this condition occurred
only in children and young adults who had been living there during the period of
tooth calcification (first 8 years of life). Parents who had emigrated there from
the eastern section of this country did not show any sign of fluorosis, nor did
children from other nearby areas in Colorado show mottled enamel. The only
conceivable difference between Colorado Springs and the nearest immune com-
munity was the source of the water supply — the communities having the children
with mottled teeth enamel received their water supply from the Pike's Peak
watershed, while the communities whose children had "normal" teeth received
thir supply from a totally different source.
DENTAL FLUOROSIS
A paper describing mottled enamel was published in 1916 (2) — the term "mot-
tled enamel" being used to designate the faulty structure of enamel caused by an
excess of fluorine. In professional circles the term "dental fluox'osis" is now fre-
quently used to designate this defect.
Reports from Italy, Holland, Argentina and South Africa established beyond a
doubt that the cause of the mottling of the enamel was in the domestic water
supply. Similar findings were reported from this country. Perhaps the most
interesting to a group of waterworks engineers is the following report by a den-
tist intimately connected with these studies. (3)
OAKLET EXPERIENCE
In the town of Oakley, Idaho, the occurrence of mottled enamel was traced
to the installation of the existing water supply. Several years before the investi-
gation, water from a warm spring in the hills was piped into the town to sup-
plant the individual shallow wells. The teeth of the children living in adjacent
ranches, beyond the town's warm spring supply, were free from mottling. When
the townspeople were apprised of the situation, they raised funds to change
the water supply. Children living in a neighboring ranch, which used as its
supply water from a nearby cold spring, had been found to have teeth without
the brown stains. On this slender evidence, the cold-spring water was turned
into the pipes a few weeks later. This was the first time that a municipal enter-
prise of such magnitude was undertaken for the sole purpose of correcting a
dental disease. When the children of Oakley were examined eight years later,
enough new teeth had erupted to show that mottling was no longer occurring.
The water supplies of these areas of mottled enamel occurrence were analyzed
many times but nothing out of the ordinary could be found. In 1931, the first
chemical evidence of the presence of fluorides in the water supply was an-
nounced. (4) The studies were performed by the Aluminum Company of America
on water from the company-owned town of Bauxite, Ark., where mottled enamel
has occurred. It is interesting to note that the first two analyses were rejected
because of the reporting of the presence of fluorine in the water sample. When
the third analysis showed the same result, the analyses were accepted.
At the same time, even more definite conclusions were reached by workers at
the University of Arizona, who produced definite dental fiuorosis in experimental
animals by feeding and injecting fluorides. (5)
The former warm spring at Oakley was found to contain eight parts per million
of fluorine and the "new" water had none. The deep well water at Bauxite had
13-14 parts per million of fluorine. The Pike's Peak watershed is known to have
extensive deposits of cryolite, a fluoride material.
FIND AGENT — ELIMINATE IT
This story of fluorine and teeth which we have presented to you has been one
of flnding the agent which disfigured the teeth and then of eliminating it. The
mottling produced by fluorides oftentimes makes the teeth pitted and notched.
Under these conditions, it was thought that these teeth should be more readily
attacked by caries. The opposite was found to be true. In 1929, a report was
published indicating that mottled enamel was actually less liable to decay. (6)
436 FLUORIDATION OF WATER
UNITED STATES PUBLIC HEALTH STUDIES
Extensive studies were conducted in the late 1930"s by the United States Public
Health Service on the epidemiology of dental fluorosis. From these studies, it
was found that in fluorine-rich areas there was relative freedom from dental
caries in deciduous teeth as well as permanent teeth of the children with a con-
tinuous exposure to the domestic water supply. Furthermore, this occurred
whether or not their teeth showed gTOss evidence of mottled enamel. (7)
The next step then was to determine just how much fluorine in the water
supply would be necessary to reduce dental caries and yet not be the cause of
mottled enamel. The United States Public Health Service found that the optimal
concentration was about one part per million.
Children using domestic waters containing at least 1.0 parts per million fluorine
experienced only about a third as much dental caries as comparable groups using
water that contained no fluorine. (8)
NEW JERSEY DENTAL SURVEYS
When the staff of the dental division of the State Department of Health
learned that 6 communities in New Jersey had had for 18 years water supplies
which contained 1-2 parts per million of fluorine, dental surveys were performed
to determine the caries rate among the children residing in those areas. It was
found that children who had had the use of fluorinated water since birth have
a lower dental caries rate than children from othe areas in the State. For
example, 12-year-old children in the so-called fluorine areas had, on the average,
only 3.2 DMF ^ teeth per cliild, compared to 5.4 DMF teeth per child in 12-year-
olds in other areas in the State. Similarly, other children's age groups studied
in fluorine areas above the 7-year level showed fewer DMF teeth. (9)
FLUORIDES RESPONSIBLE FOR LOWER CAEIES RATE
Meanwhile, other findings indicated that fluorides were alone responsible for
a lower caries rate. Decayed teeth showed a lower fluoride content than did
nondecayed teeth from the very same mouth (10). Teeth shaken in fluoride solu-
tions were less soluble in mineral acids than were teeth not so treated (11).
Topical applications of a 2-percent sodium fluoride solution to the teeth of chil-
dren showed a 20-40-percent reduction in new dental caries (12). All of these
reports added what seemed to be convincing evidence of the importance of this
newly found caries-inhibitory agent.
One more link in the chain of evidence remained to be forged : Would the addi-
tion of 1 part per million of fluorine to an erstwhile fluorine-free public water
supply also reduce dental caries? At least seven controlled studies are at pres-
ent being conducted to answer this final question ( 13 ) . Recently the New York
State Department of Health published a preliminary report of their 2-year expe-
rience of adding 1 part per million fluorine to the Newburgh water supply. En-
couraging indeed is the observation that there has occurred a decrease in the
susceptibility of this city's children to tooth decay. No toxic effects have been
discovered from the minute amounts of fluorine added to the water (14).
RESULTS OF FLUORINATED SUPPLY
It has been estimated that a fluorinated water supply will produce the follow-
ing results, compared to nonfluorinated water :
1. Six times as many children having no dental caries experience.
2. Sixty percent lower dental caries experience rate.
3. Seventy-five-percent decrease in the first permanent molar loss (15).
4. Ninety-percent reduction in tooth-surface caries in upper anterior teeth (16).
The situation then appears to be thus: A concentration of about 1 part per
million naturally borne fiuorine in the public water supply has reduced the inci-
dence of decay in the teeth of children who have been reared in the area. P.eyond
1.5-2 pai-ts per million fluorine, mottled enamel may occur. The optimal con-
centration appears to be about 1 part per million, which will reduce the incidence
of new caries and not produce mottled enamel. Investigations are proceeding to
determine the advisability of fluorinating the public water supply. Results will
be reported in a few years.
[iDMF teeth — permanent teeth showing evidence of dental caries experience (permanent
teeth requirinj? fillincr — permant teeth extracted — permanent teeth requiring extractions —
filled permanent teeth).
FLUORIDATION OF WATER 437
EXPERIMENTAL PROGRAMS
Meanwhile, interested communities have been inquiring about the possibilities
of fluorinating a domestic water supply in New Jersey. What attitudes should
we as representatives of the State department of health and you as members
of the New Jersey section of the American Water Works Association assume?
Certainly we should not be justified in recommending widespread addition of
fluorine to the communal water supplies in our State. We should, however, be
prepared to set up 1 or 2 experimental programs, adding 1 part per million fluorine
to the water supply in 1 or 2 selected communities for the following reasons :
1. The yearly cost is relatively low — 9 cents per capita ( 17) .
2. The evidence indicates that the dental-caries rate is lower among children
reared in a community with a communal water supply having 1 part per million
fluorine.
3. No injurious concomitants have been revealed from the addition of 1 part
per million fluorine to communal water supply.
4. It would be advantageous to citizens of New Jersey if a demonstration study
were made. Not only would we be more certain of the results of adding fluorine
to a water supply but also information about the installation and maintenance
would be more readily available to New Jersey authorities.
It would seem to be appropriate, therefore, for your organization to collaborate
with the State department of health and the New Jersey State Dental Society
in the proposed investigation in order to consider subsequent action on this mat-
ter with convincing authority.
References
(1) Wisan, J. M., and Chilton, N. W. : "Studies in Dental Public Health Ad-
ministration. IV. The dental caries experience of New Jersey children." Jour-
nal of the American Dental Association ( in press ) .
(2) Black, G. V., in collaboration with McKay, F. S. : "Mottled teeth; an en-
demic developmental imperfection of the enamel of the teeth heretofore un-
known in the literature of dentistry," Dental Cosmos, 58: 129-156 (February) ;
477_iS4 (May) ; 627-644 (June) ; 781-792 (July) ; 894-904 (August), 1916.
(3) McKay, F. S. : "Fluorine and Mottled Enamel" in Fluorine and Dental
Health, Symposium of the New York Institute of Clinical Oral Pathology (Octo-
ber 30), 1944, New York.
(4) Churchill, H. V. : "Occurrence of Fluorides in Some Waters of the United
States." Journal of Industrial and Engineering Chemistry, 23: 996-998 (Sep-
tember), 1931.
(5) Smith, M. C, Lantz, B. M., and Smith, H. Y. : "The Cause of Mottled
Enamel, a Defect of Human Teeth." University of Arizona College of Agricul-
ture Bulletin. 32 : 2.53-282, 1931.
(6) McKay, F. S. : "The establishment of a definite relation between enamel
that is defective in its structure, as mottled enamel, and the liability to decay."
Dental Cosmos, 71 : 747-755 (August), 1929.
(7) Dean, H. T. : "Endemic fluorosis and its relation to dental caries," Public
Health Reports, .53: 1443-1452 (August 19), 1938.
(8) Dean, H. T., Jay, P., Arnold, F. A., and Elvove, E. : "Domestic water and
dental caries. II. A study of 2,832 white children, age 12 to 14 years, of 8 sub-
urban Chicago communities * * *." Public Health Reports, 56: 761-792 (April
11), 1941.
(9) Wisan, J. M. : "Dental Caries and Fluorine Water. " Public Health News,
27 : 5. State Department of Health, Trenton. N. J. (1947) . page G42.
(10) Armstrong, W. D., and Brekhus, P. J.: "Possible relationship between
the fluorine content of enamel and resistance to dental caries." Journal of
Dental Research, 17 : 393-399, 1938.
(11) Volker. J. F. : "Effect of fluorine on solubility of enamel and dentin."
Proc. Soc. Exp.'Biol. and Med., 42 : 72.5-727 (December), 1939.
(12) Knutson, J. W., and Armstrong, W. D. : "The effect of topically applied
sodium fluoride on dental-caries experience." Public Health Reports, 58: 1701-
1715 (November 19), 1943; 60: 1005-1090 (September 14), 1945; 168.3-1689 (No-
vember 22), 1946.
(13) Dean, H. T. : "Fluorine and Dental Caries. I. Epidemiological Aspects,"
Proc. Washington Section Internat. Assn. Dental Res., Journal of Dental Re-
search, 26 : 339 (August) , 1947.
(14) New York Herald Tribune, September 27, 1947.
438 FLUORIDATION OF WATER
(15) Arnold, F. A., Jr.: "Role of fluorides in preventive dentistry," Journal
of American Dental Association, 30 : 499-508 (April) , 1943.
(16) Report of Committees on the Use of Fluorides in the Control of Caries,
University of Michigan Workshop of the Evaluation of Dental Caries Control
Techniques ; Ann Arbor, Mich., 1947, page 36.
(17) Cox, Charles R. : "How To Feed Fluorine," Engineering News-Record,
Wallace & Tiernan Co., Newark, N. J., July 10, 1947, page 67.
Fluorine Content of the Water Supplies of New Jersey
(By John E. Bacon, Chief, Bureau of Chemistry, New .Jersey State Department
of Health )
[Presented before New Jersey section, American Water Works Association, and
South Jersey Water Superintendents, Atlantic City, N. J., Nov. 7, 1947]
Sometime before 1935 the publications of many investigators (1, 2, 3) estab-
lished conclusive proof that the causative agent for the production of mottling of
teeth in some communities was excessive fluorine in the drinking water supply.
The examination of the public water supplies of New Jersey for the fluorine con-
tent was begun in 1935, when 40 percent were examined. Only four exceeded the
safety limit accepted at that time, of 1.0 p. p. m. of fluorine. These cities were :
Glassboro, 1.6 p. p. m. F ; Mullica Hill, 1.6 p. p. m. F ; Woodbury, 1.4 p. p. m. F ;
Blackwood, 1.1 p. p. m. F, all in south Jersey.
At the end of 1935, the picture of the public water supplies of New Jersey was
as follows :
107=Total number of supplies examined.
19 percent of supplies had F content of 0 to 0.10 p. p. m.
38 percent of supplies had F content of 0.15 to 0.25 p. p. m.
32 percent of supplies had F content of 0.30 to 0.50 p. p. m.
7 percent of supplies had F content of 0.60 to 1.00 p. p. m.
4 percent had F content greater than 1.00 p. p. m.
A dental survey of the teeth of the schoolchildren of Woodbury was promptly
undertaken by our district health officer from the Pitman area. Very slight
evidence of mottling of the enamel of the teeth was found.
The conclusion was reached, "There was no evidence of endemic fluorosis in
New Jersey." In fact, the New Jersey State Department of Health felt quite
pleased with the low fluoride content of the public water supplies of the State,
as you will recall at that time fluorine in drinking water was considered
deleterious.
ALL PUBLIC water SUPPLIES WITH HIGH F LOCATED IN SOUTH JERSEY
Mention has been made that in 1935 four public water supplies, all in south
Jersey, were found to contain fluorine in amounts exceeding that accepted by
health officials at that time, but all other supplies in the State were within the
so-called safety limit. Fluorine examinations were subsequently made of public
water supplies in areas contiguous to those where high fluorine values had been
found, and the water supplies in four additional cities were found to exceed 1.0
p. p. m. F, namely :
Clarksboro, 1.1 p. p. m. ; Mantua, 1.3 p. p. m. ; Wenonah, 1.3 p. p. m. ; Woods-
town, 1.8 and 2.4 p. p. in.
If you refer to a map of New Jersey it will be seen that all these public water
supplies are in comnuinities grouped within an area having a 15-mile radius
around the town of Glassboro, in southwestern New Jersey. Excepting Woods-
town, in Salem County, all the communities are located in Gloucester County,
a roughly rectangular area some 10 miles wide and 30 miles long, extending from
the Delaware River on the west to about the middle of the State to the east,
where it adjoins Atlantic County. To the north it is bounded by Camden County,
and on the south largely by Salem County. The towns have artesian well supplies
500-700 feet deep. On the other hand, many examinations of the water from
shallow wells within this area showed the fluorine content to be of the magnitude
of 0.2 p. p. m. F.
Why is the fluorine content of water from deep artesian wells in this small
area in New Jersey so much higher than in other parts of the State? Some
theories have been advanced, not too convincing.
FLUORIDATION OF WATER 439
FLUORINE IN WATER SUPPLIES CLAIMED TO REDUCE DENTAL CARIES
Around 1940 the public health concept of the deleterious action of fluorine in
drinking water began to change, as the investigations of many (4, a) sup-
ported the theory that small amounts of fluorine, not exceeding 1 to 1.5 p. p. m.,
was very beneficial; decay of the teeth was inhibited, yet mottling of the enamel
of the teeth was not produced by such amounts. The new drinking water stand-
ards of the United States Public Health Service, adopted in 194G, permit fluorine
to be present to the extent of 1.5 p. p. m. in water supplies used on interstate
carriers. This is an increase of 0.5 p. p. m. fluorine over the previous standard.
This action presumably was taken following the changed public health view as
to the beneficial action of small amounts of fluorine in combating dental caries.
FLUORINE CONTENT OF NEW JERSEY WATER IN 1945
In 1945 the fluorine content of approximately 80 percent of our public water
supplies and many surface waters were determined. The work was undertaken
to bring our information up to date and to supply the many requests received
from health officials and the public for information as to the fluorine content in
the public potable water supplies in New Jersey. Such requests were probably
induced by the publicity given dental health programs regarding the effect of
fluorides on dental caries, and to litigation that arose in southern New Jersey as
a result of the release of fluorine fumes by certain manufacturing establishments
located in this general area.
PUBLIC WATER SUPPLIES
In New Jersey 95 percent of the population of 4,160,165 (1940 census) are
served by 270 public water supplies. A tabulation of the fluorine results obtained
in the 1945-46 examinations shows :
227=Total number of supplies examined.
42 percent of supplies with F content of 0 to 0.10 p. p. m.
47 percent of supplies with F content of 0.15 to 0.25 p. p. m.
7 percent of supplies with F content of 0.30 to 0..50 p. p. m.
1 percent of supplies with F content of 0.60 to 1.00 p. p. m.
3 percent of supplies with F content greater than 1.00 p. p. m.
An appreciable number of the streams, lakes, and surface waters of the State
were also examined, with the following results :
83=Total number of samples examined.
17 percent of samples had F content of 0 to 0.10 p. p. m.
70 percent of samples had F content of 0.15 to 0.25 p. p. m.
7 percent of samples had F content of 0.30 to 0..50 p. p. m. .
5 percent of samples had F content of 0.60 to 1.00 p. p. m.
1 percent of samples had F content greater than 1.00 p. p. m.
CHIEF engineer's CONCLUSIONS
The following conclusions were drawn from these fluorine examinations by
Chief Engineer Croft of the bureau of engineering and sanitation in the annual
report of the New Jersey State Department of Health for the fiscal vear ending
June 30, 1946.
1. The fluorine content of the surface waters in New Jersey did not exceed
the standard set by the United States Public Health Service in any instance.
2. Three public water supplies, all in southern New Jersey, exceeded the
standard set by the United States Public Health Service in the matter of fluorine
content.
3. 99 percent of the public water supplies surveyed in New Jersey during the
current fiscal year delivered a water to consumers containing fluorine in quan-
tities less than the maximum limit set by the United States Public Health Service.
EXAMINATION OF PUBLIC WATER SUPPLIES IN 194 6
At the end of the last fiscal year all the public water supplies in New Jersey
had been examined for the fluorine content and the pattern closely resembled
that for the preceding year 1945-46. 222=Total number of supplies examined.
61 percent of supplies had F content of 0 to 0.10 ppm.
440 FLUORIDATION OF WATER
34 percent of supplies had F content of 0.15 to 0.25 ppm.
2 percent of supplies had F content of 0.30 to 0.50 ppm.
0.5 per cent of supplies had F content of 0.60 to 1.00 ppm.
2.5 percent of supplies had F content greater than 1.00 ppm.
ADDITION OF FLUORINE TO PUBLIC WATER SUPPLIES
A quick glance at these tabulations shows that 92 percent of the 449 public
water supplies examined have a fluorine content of 0.25 ppm. or less, yet the bene-
ficial effect of fluorine in the range of 1.0 to 1.5 ppm. in drinking waters in com-
bating dental caries has much support from public health officials. Many are
insisting that where water supplies do not contain sufiicient fluorine to be effec-
tive in reducing dental caries, that the public be given the added amounts needed
by introduction of fluorides into the public water supplies. Many of you may
remember the arguments and reasons advanced years ago in connection with the
cry for fortification of public water supplies with iodides to prevent thyroid
conditions. The final result — iodized salt.
NEWBURGH EXPERIMENT
The department is watching with great interest in the long-range experiment
being conducted in the city of Newburgh, N. Y. Here fluorides are being added
to the public water supply to bring the amount to 1.00 ppm. Dental surveys of
schoolchildren have and will continue to be conducted. Comparisons will be
made with like surveys undertaken upon the schoolchildren of the nearby city
of Kingston, where the fluorine content of the drinking water is low and approxi-
mates the amount in Newburgh before fortification. The preliminary results are
very promising, indicating that added fluorine does reduce dental caries. How-
ever, long-range scientific investigations are in progress in the following cities :
Brantford, Ontario; Evanston, 111. ; Grand Rapids, Mich. ; Marshall, Tex. ; Mid-
land, Mich. ; Ottawa, Kans. ; Sheboygan, Wis. ; Madison, Wis.
The results must be evaluated before conclusions are reached that public water
supplies should be treated with fluorides as a routine procedure. Furthermore,
if the consensus of sanitarians is that additional amounts of fluorine to the water
supply do combat and reduce dental caries, then the best method of getting same
to the people, whether via the public water supply or some other less wasteful pro-
cedure, will eventually be determined by the crystallization of the opinions of
many. Waterworks officials will play an impoi-tant part in the final decision as
it affects individual communities. In all discussions that portion of the public,
small in New Jersey but sizable in some States, not served by public water sys-
tems must be considered. The United States Public Health Service considers the
high rate of dental caries in New Jersey one of our foremost health problems.
References
(1) Churchill, H. V. Occurrence of Fluorides in Some Waters of the United
States. Ind. Eng. Chem., 23:996-998 (1931).
(2) Smith, M. C. ; Lantz, E. M. ; and Smith, H. V. Cause of Mottled Enamel, a
Defect of Human Teeth. Tech. Bull. No. 32, Univ. Ariz. Agri. Exper. Station,
Tucson (1931).
(3) Dean, H. Trendley, and Elvove, Elias. Studies on the Minimal Threshold
of the Dental Sign of Chronic Endemic Fluorosis. United States Treasury
Department Public Health Reports, 50:49:1719-1729 (1935).
(4) Dean, H. Trendley, D. D. S. Fluorine, Mottled Enamel and Dental Caries.
Journal of Pediatrics, St. Louis, 16 : 6 : 782-794 (June 1940).
(5) Dean, H. Trendley ; Jay, Philip ; Arnold, Francis A.. Jr. ; and Elvove, Elias.
Domestic Water and Dental Caries, United States Public Health Service Reports,
56:15:761-792 (Apr. 11, 1941).
Dental Caries and Fluorine-Water
(By J. M. Wisan, D. D. S., M. S. P. H., chief, dental health bureau,
State Department of health)
As a result of many fluorine studies interest has mounted in the possibilities
of reducing the prevalence and incidence of dental decay by the use of fluorine
compounds.
FLUORIDATION OF WATER 441
When it was revealed ^ that six communities ^ in New Jersey had public
water supplies with fluorine content between 1 and 2.4 parts per million, the
bureau of dental health immediately began a preliminary study. The purpose
of the study was to compare dental conditions among the school children of these
"fluorine" communities with dental conditions found among children where
the public water supply contained relatively little or no fluorine.^
As Hill 4 points out, to study problems of clinical trial one must have (1) two
groups similar in all respects except the form of treatment, (2) a criterion for
determining conditions among the two groups, and (3) sufiiciently large number
of individuals to give reliable results.
To meet the first requirement, children of 26 communities with no fluorine
in public water supply were surveyed. No selection was made except that only
children in suburban and rural counties were included. This precaution was
taken because none of the fluorine communities could be considered urban. The
data were collected by specific ages. Because in both situations males and
females were in the same proportion no attempt was made to analyze data
according to sex. The examinations — mouth mirror and explorer — were con-
ducted in both situations with similar techniques and directions.
Two criteria were used for determining dental conditions among the two
groups :
( a ) DMF rate per child by specific ages ;
{h) Percentage of children with no DMF teeth by specific ages.
For the reader unfamiliar with the term DMF, the following explanation is
given. DMF is a term which includes four dental categories: (1) Permanent
teeth decayed requiring filling D; (2) teeth decayed now requiring extraction;
(3) teeth missing because of previous extraction — both (2) and (3) are included
as M teeth; (4) teeth previously filled (now in sound condition) F. If one ana-
lyzes these 4 categories which make up the total of DMF teeth, one will note
that the sum of all DMF teeth in individuals under 20 will give an accurate esti-
mate of all teeth that are or were subject to decay.
Thus the first criterion mentioned above — DMF rate per child — acti;ally gives
one the number per child of teeth that experienced decay, while the second
criterion — percentage of children with no DMF teeth — would show the percentage
of children who had had no decayed teeth.
To assure sufiiciently large numbers in our studies we included all communi-
ties of suburban and rural character where dental inspections had been conducted
by specific ages and where data were obtained with the same techniques as used
in fluorine areas.
Another precaution was taken in the "fluorine" areas. Children were divided
into two groups — those who lived in communities before and after the fourth
birthday and those who moved into the communities after the fourth birthday.
When an attempt was made to further subdivide the children who lived in the
community before the second birthday it was found with very few exceptions
that children, whom we had classified as living there before and after the fourth
birthday, lived there before the second birthday as well.
Table I shows DMF rate of public-school children in 26 New Jersey communi-
ties where no fluorine (or too little fluorine) was found in public water supply.
1 The department is indebted to Dr. Jack S. Hyman for his cooperation in this study
- Communities included in this survey were : Blacliwood, Glassboro, Mantua, Mullica Hiil,
Wenonali, and Woodstnwn.
» The hypothesis is that fluoride of 1 to 2 parts per million in the public water supply will
lower the prevalence of dental caries without causina: fluorosis (mottled enamel)
« Principles of Medical Statistics, A. Bradford Hill, vol. Ill, 2d edition Tlie Lancet
London, 1939, p. 172. ' '
442
FLUORIDATION OF WATER
Table I.- — DMF rate: PuMic-school children in 26 New Jersey "^i on fluorine"
communities 1944 — Mouth mirror and explorer exam,ination in schoolroom
Age (last birthday)
Number
examined
DMF per
child
Age (last birthday)
Number
examined
DMF per
child
6
488
599
608
566
561
572
0.64
1.5
2.4
3.0
3.6
4.3
12
611
566
490
376
320
365
5.4
7 -- .-
13
6.5
8
14
8.3
9
15
9.4
10
16
10.8
11
17
11.9
Table II. — DMF rate of puhlic-school children ivho lived before and after the
4th birthday in fluorine communities
Age Oast birthday)
Number
examined
DMF per
child
Age Oast birthday)
Number
examined
DMF per
child
6
111
112
121
94
88
101
0.4
.9
1.4
1.6
2.1
3.1
12
13
14
15
90
100
92
58
36
3.2
7 . -
4.3
8
4.5
9 .
4.4
10
16
4.2
11 .
Table III.— DMF rate of children moving in fluorine communities after 4th
birthday
Age (last birthday)
Number
examined
DMF per
child
Age Oast birthday)
Number
examined
DMF per
child
6 - ---
12
28
32
43
35
41
0.08
2.1
1.8
2.9
2.9
4.1
12
56
47
36
33
19
5.7
7 .
13
6.7
g
14
6.5
9
15
16
7.2
10 . --
6.2
11
Table IV compares the two groups in fluorine communities with the group in
nonfluorine areas.
Table IV. — DMF per child by ages
Age
26 New
Jersey
communi-
ties non-
fluorine
Moved in
community
after 4th
birthday
Lived in
fluorine
community
befnre and
after 4th
birthday
Age
26 New
Jersey
communi-
ties non-
fluorine
Moved in
community
after 4th
birthday
Lived in
fluorine
community
before and
after 4th
birthday
6
0.64
1.50
2.40
3.00
3.60
4.30
0.08
2.10
1.80
2.90
2.90
4.10
0.4
.9
1.4
1.6
2.1
3.1
12
5.40
6.50
8.30
9.40
10.80
5.70
6.70
6.50
7.20
6.20
3.2
7
13
4.3
8
14
4.5
9
15
4.4
10 - -
16.
4.2
11 .
Illustration I presents graph of data in tables I, II, and III.
FLUORIDATION OF WATER
443
Illustration 1
COMPARISON OF DMF RATE
N. J. COMMUNITIES-HIGH AND LOW FLUORINE CONTENT WATER
J
1
;
'
«>■
/
n-
V
;i
i "■
s."
n.
;i
■5'
V?
1
/
3.-"
^~~?
i
?
•>
/
^■■'
-"'i
L
■I
4
1"
1
1
/
/
/
■''")
^^^V
tt
■"
/
K
b 7 & 3 10 11 IZ 13 H 15 lb 17
AGES
DMF — 26 New Jersey Communities — Low Fluorine
DMF — Children moving into high fluorine community after
fourth birthday
DMF — Children having lived before and after fourth birthday
fluorine community.
48391—54
-2fl
444
FLUORIDATION OF WATER
Table V.
-Data to show difference in nvmber and percentage of children having
no DMF teeth in fluorine and non fluorine areas
Number examined
Number with no
DMF teeth
Percentage with no
DMF teeth
Age (last birthday)
Non-
fluorine
areas
Fluorine
areas
Non-
fluorine
areas
Fluorine
areas
Non-
fluorine
areas
Fluorine
areas
6 _
437
440
474
570
508
534
512
569
486
546
518
341
96
101
117
94
92
110
89
100
93
59
38
17
299
167
108
168
31
25
27
20
14
12
19
7
66
55
55
37
28
31
20
17
16
8
6
3
69
37
23
29
6
5
5
4
3
2
3
2
68
7
54
8 .
47
9...
39
10 -
30
11 . .
28
12 --
22
13
17
14 .
17
15
14
16 .
16
17
18
The University of Pittsburgh,
Pitts-burgh, Pa., May 11, 195-',.
Hon. Charles A. Wolverton,
Chairman, Committee on Interstate and Foreign Commerce,
House of Representatives, Washington, D. C.
Dear Mr. Wolverton : I am presuming upon my acquaintance witli you when
I vpas Surgeon General of the United States Public Health Service to write to
you in opposition to H. R. 2341. In my opinion this bill would not protect the
public health, quite to the contrary.
It was during the time that I was Surgeon General that studies were made
by the United States Public Health Service of the relationship between fluorida-
tion of water and dental caries. I shall not attempt to give you a summary of
the research findings since I am sure they will be presented in detail to your
committee. Suflice it to say that I have continued to follow the literature regard-
ing fluoridation of water supplies. It is my considered judgment that the addi-
tion to municipal water supplies of fluorine in the amounts recommended has
a demonstrated value in reducing the amount of dental caries in the population
served and that there is no valid evidence that fluorine in the amounts recom-
mended has any deleterious effects whatever upon the public health.
During the past several years I have served as a member of the national Com-
mission on Chronic Illness and as a member of its executive committee. This
commission was asked more than a year ago to make a statement concerning
the effects, if any, of fluoridation of community water supplies upon the aged
and chronically ill. We appointed a special committee under the chairmanship
of Dr. Kenneth F. Maxcy, professor of epidemiology, Johns Hopkins University
School of Hygiene and Public Health. The other members were Dr. Edward J.
Stieglitz, outstanding geriatrician of Washington, D. C, and Dr. Nathan Shock,
Chief of the Section on Gerontology, National Institutes of Health, Public Health
Service. This committee in March 1954 submitted a report to the Commission
on Chronic Illness a copy of which is attached. After considering this report
the commission accepted it and recommended "American communities to adopt
this public health measure (fluoridation) as a progressive step in the prevention
of dental caries."
I hope that my statement will be made a part of the record of your committee.
With personal regards, I am
Sincerely,
Thomas Parran, M. D., Dean
CHRONIC ILLNESS NEWS LETTER
Issued monthly by the Commission on Chronic Illness — an inde-
pendent national agency founded by the American Hospital
Association, American Medical Association, American Public
Health Association, and the American Public Welfare Association,
for the purpose of studying problems of chronic disease, illness,
and disability.
,'^ FLUORIDATION OF WATER 445
Fluoridation' of Watkr Suitliks Endorsed by Commission
AT Annual Meeting
The statement below on the effects of fluoridation of community water supplies
upon the aged and chronically ill was adopted by the Commission on Chronic
Illness at its fifth annual meeting in Chicago on March 18
Prevention of the occurrence of disease — or prevention of its progress — is
generally accepted as tlie most desirable solution to the growing problem of
chronic illness in this country. The Commission on Chi-onic Illness is interested
in furthering the adoption and use of any public health measures that will
contribute to the prevention of chronic illness.
Fluoridation of community water supplies has been undertaken by many
communities as the public-health measure directed toward the prevention of
dental caries. Fluoridation of public water supplies has been endorsed by lead-
ing professional organizations in the field. Dental caries is an important chronic
disease — ^important in terms of widespread prevalence and destruction of useful
tissue — also important in the way that resulting loss of teeth may complicate
the life of aged persons and persons suffering other disabling conditions.
Tlie major portion of scientific opinion is tliat fluoridation of water supplies
for the prevention of dental caries presents no hazard to public health.* A
minority view is held by a number of qualified scientists who believe that the
safety of this procedure has not been sufficiently demonstrated. Cognizant of
the fact that fluoride compounds in large doses are poisonous, they advance the
hypothesis that the small amounts contained in fluoridated water consumed
over many years may by cumulation have subtle physiological effects especially
detrimental to the aged and the chronically ill.
The commission, concerned with the ijroblems of chronic illness, did not feel
that it could recommend fluoridation of public-water supplies without first taking
cognizance of the possibility of detrimental effects. At the request of the board
of directors of the commission, a committee of distinguished scientists reviewed
and evaluated the available evidence to decide whether at this time a positive
position could be taken with regard to this hypothetical danger. The committee
was under the chairmanship of Dr. Kenneth F. Maxcy, professor of epidemiology,
Johns Hopkins University School of Hygiene and Public Health, Baltimore. The
other memljoj-.'; were Dr. Edward J. Stieglitz, outstanding geriatrician of Wash-
ington, D. C, and Dr. Nathan Shock, Chief of the Section on Gerontology,
National Institutes of Health, Public Health Service. This committee reports
as follows :
"The basic facts concerning fluoridation which have been established by the
investigations of the past 20 years have been briefly set forth in the report of
the Ad Hoc Committee on Fluoridation of the National Research Council."
Under normal conditions of living, fluorine is a trace element in human nutrition.
Although minute amounts are present in certain foods and beverages, a variable
and important source is drinking water. Public water supplies vary widely
in the amount of fluoride naturally present. Children dependent upon supplies
that are low in fluorides have a high dental caries attack rate as compared to
children living in communities having water supplies containing about 1 part
per million or more of fluoride. The advantage to the latter gi-oup is consider-
able : the incidence of carries is reduced by one-half to two-thirds. The caries
preventive effect of adequate fluoride intake is principally conferred upon
children up to the 12th year of life, during the period when dentine and enamel
of permanent dentition are being formed. However, increased resistance to
dental caries is carried over into later life to an appreciable degree.
"When the trace quantities in drinking water required for optimal dental
health are exceeded, undesirable physiological effects may be induced. The most
sensitive indication of the latter is interference with normal calcification of
the teeth, which is manifested in mottled enamel. This effe<t, although com-
patible with caries-resistant tooth structure, is esthetically undesirable. The
level of fluoride concentration in di-inking water which is associated with the
appearance of mottled enamel varies with individual susceptibility and the
amount of water consumed. T'nder the climatological conditions of the north-
^ The Fluoridation of Domestic Water Supplies in North America as a Means of Con-
trolling Dental Caries. lA report of the United Kingdom Mission, Ministry of Health,
Department of Health for Scotland. lOS.*?.
? National Research Council Viewpoint on Fluoridation. Journal American Waterworks
Association, vol. 44. No. 1. January 1052.
446 FLUORIDATION OF WATER
em part of the country it is reached when the fluoride content of domestic water
supplies exceeds 1.5 p. p. m.
"In view of these facts, Trendley Dean ^ and his associates developed the
hypothesis that by adding fluorides in proper amounts to water supplies which
were defiicient or low in this element it was possible to afford optimum caries
preventive effect without causing mottled enamel. Controlled studies were begun
in 1945 to test this hypothesis in Grand Rapids, Mich. ; Muskegon, Mich. ; Aurora,
111. ; * and in Newburgh and Kingston, N. Y.° Results now available from these
studies are such as to deflnitely establish that the protection against caries given
by naturally occurring fluorides is also conferred by water to which this element
has been added. Careful annual medical examinations of children in the latter
study including X-rays, urine analysis, and other laboratory tests over a 6-year
period have failed to uncover any adverse effect from fluoridated drinking water.
The children in Newburgh drinking fluoridated water showed no significant
deviation in height or weight growth from those in Kingston where the water
was essentially fluoride free.
"The question posed by the minority of scientists is w^hether fluoride added to
drinking water in quantities insulEcient to cause mottled enamel (i. e., to a level
of approximately 1 part per million) have, by cumulation in tissues, any physi-
ological effects which may be detrimental to adults and to the chronically ill.
Information bearing upon this question has been derived from two sources: (1)
Studies on the metabolism of fluorides in man and in experimental animals;
(2) observations on human populations exposed to water supplies having a
fluoride content in excess of 1.5 parts per million.
"The extensive literature dealing with metabolism and toxicology of fluoride
compounds has been reviewed by the National Institute of Dental Research,
United States Public Health Service '^ and in an article by F. F. Heyroth in the
Journal of the American Public Health Association.' In our judgment there has
been a suflficient number of observations on human subjects, with support of ani-
mal experiments, to establish the pattern of metabolism. Up to a daily intake
of 4 or 5 milligrams or more fluorides absorbed are almost completely eliminated
in the urine and sweat. (To get 5 milligrams of fluoride daily one would have
to drink about 5 quarts of water containing 1 part per million of fluoride every
day.) Any residual is stored in the skeletal system, teeth and bones. Little, if
any, remains in the soft tissues, liver, spleen, kidneys, etc. As the level of intake
is lowered, stored fluorides tend to be partially eliminated. At high levels of
fluoride intake (8 parts per million or more) changes occiir in bones which may
become evident by X-ray (bone fluorosis). However, storage of fluorides in the
skeletal structure in the amounts considered here results in no functional dis-
advantage. In other words, the body possesses two potent protective mecha-
nisms: (1) rapid excretion in the urine; (2) storage in the skeleton.
"These studies of metabolism have been supplemented by a considerable num-
ber of observations on population groups naturally exposed for long periods of
time to water supplies with varying fluoride content. In the United States, more
than a million people, served by 453 different water supplies have, for genera-
tions used drinking water with a natural fluoride content from 1.5 to 8.0 parts
per million. No deflnite evidence has been forthcoming that continued consump-
tion of such water is in any way harmful to health. There have been no reports
of evidence of changes in bone structure when the water supply contained less
than 5 parts per million.
"In a radiologic survey of 114 persons who had lived for at least 15 years at
Bartlett, Tex., where the water supply contained 8 parts per million, 12 percent
of those examined showed minimal X-ray evidence of increased density of the
bones but in no case was there any deformity or interference with function.
Medical examinations, which included urinalysis and blood counts, revealed no
indication that the residents of Bartlett were less healthy than those of nearby
Cameron, where the water contained only 0.3 part per million. Reports of bone
f Formerly Director, National Institute of Dental Research. National Institutes of Health.
* Effect of Fluoridated Public Water Supplies on Dental Caries Prevalence. Public
Health Reports, by Francis A. Arnold, Jr., D. D. S., H. Trendley Dean, D. D. S., and John
W. Knutson, D. D. S., Jr. P. H., vol. 68, p. 141, February 1053.
» Ncwburgh-Kinsston Caries Fluorine Study V — Pediatric Aspects — Continuation Report,
by Edward R. Schlesinger, M. D., David B. Overton, M. D., and Helen C. Chase, M. Sc,
Journal American Public Health, vol. 43, p. 1011, August 1953.
« Unpublished memorandum. Copy in the files of Commission on Chronic Illness.
T ToxicolORical Evidence for the Safety of the Fluoridation of Public Water Supplies, by
Francis F. Heyroth, M. D., Journal of American Public Health, vol. 42, p. 1568, December
1952.
FLUORIDATION OF WATER 447
fluorosis in studies conducted in Italy, India, South Africa, and Argentina indi-
cate similar relationships to the use of high fluoride bearing waters.
"It is to be emphasized that the proponents of fluoridation of water recognize
that excessive ingestion of fluorides is undesirable and that, where practical, they
should either be removed by a treatment process or new sources of supply sought.
They stress the necessity of keeping the fluoride content of drinking water below
the level of that which causes mottled enamel, the most sensitive indication of
an excess.
"On the hypothesis that a higher incidence of chronic disease would be reflected
in higher mortality rates due to specific causes, the experience of cities with
water supplies having a high fluoride content has been compared with that of
cities having a low fluoride content. The most recent and comprehensive study '
of such data is one compiled by the United States Public Health Service and
based on the 1949-50 census reports. In this analysis of mortality rates, all
cities in the United States with 10,000 population or over in 1950, whose drink-
ing water contained 0.7 part per million or more of fluoride naturally present
were considered for inclusion. Each fluoride city was paired with the average
of the three closest fluoride-free cities (with less than 0.2 part per million fluoride
with populations of 10,000 and over. Deaths from cancer, heart disease, and
nephritis per 100,000 population, adjusted for age, sex, and race in 28 fluoride
and in 60 nonfluoride cities failed to show significant differences.
"It is the contention of the minority that epidemiological studies or analysis of
vital statistics cannot be relied upon to determine whether the condition of sick
persons, such as those afflicted with chronic illness, particularly kidney ailments,
would or would not be worsened by the ingestion of fluoridated water. Although
the data are limited, experiments recently carried out at the National Institute
of Dental Research on somewhat more than 50 cases who have evidence of dam-
aged kidney fimction and who use drinking water containing 1 part per million
of fluoride have come to our attention. The results indicate that the excretion
pattern of fluorides in these patients with damaged kidneys is similar to that
reported by McClure" for healthy young men. The collection of negative evi-
dence such as this for an absolute determination of no possible effect of fluorides
in persons suffering from chronic illnesses is an endless and extremely compli-
cated undertaking. Generally speaking, consideration of the primary factors
in the causation of such illnesses far overshadows any minor or secondary effects
which, in the light of present knowledge, could be assumed from ingestion of
trace amounts of fluoride in drinking water."
The commission has been advised by the foregoing expert opinion that exten-
sive research into the toxicology of fluorine compounds has revealed no definite
evidence that the continued consumption of drinking water containing fluorides
at a level of about 1 part per million is in any way harmful to the health of
adults or those suffering from chronic illness of any kind. While the evidence
does not absokitely exclude this possibility, if a risk exists at all it is so minimal
and inconspicuous that it has not been revealed in many years of investigation.
The commission, therefore, urges American communities to adopt this public-
health measure as a positive step in the prevention of the chronic disease, dental
caries.
The fluoridation of water supplies involves no new experience in human wel-
fare. Over 3 million people are living in ordinary good health on water naturally
containing fluorides in the amounts recommended for caries control, or more.
The Role of Dentistry In Chronic Illness
[Reprinted by permission of Dental Health Highlights]
The American people are showing increasing concern over the complex prob-
lems of chronic illness — its prevention and the need of adequate care for persons
who are chronically disabled. The dental profession shares this concern and is
working closely with representatives of other health professions who likewise
have a stake in human rehabilitation.
On March 18 to 20, a National Conference on Care of the Long-Term Patient
was held in Chicago under the auspices of the commission on chronic illness.
Some 400 representatives of 37 national health organizations and agencies
learned that the overall — and almost overwhelming — problem of the care of the
long-term patient is a problem of many segments, one of which is dental care.
^Data in files of Commission on Chronic Illness.
» McClnre. F. J., and Kinser, C. A., Fluoride Domestic Waters and Systemic Effects.
Public Health Reports, vol. 59, p. 1575, 1944.
448 FLUORIDATION OF WATER
Dr. David W. Brock,, chairman of the council on dental health, is the American
Dental Association's oflScial representative on the commission, and he and other
dentists participated in the discussions. Dr. Brock presented to the conference
the newly prepared statement adopted by the council on dental health entitled,
"The Role of Dentistry in Chronic Illness." The statement, which is scheduled
for publication in the May issue of the Journal of the American Dental Associa-
tion, has five salient points which are listed in the following text :
1. A concept frequently overlooked is that many dental diseases are or may
become chronic. Among these conditions are dental caries, gingivitis, advanced
periodontal disease, and malocclusion.
2. Many of the major chronic illnesses have direct implications in the field of
dentistry. Among these illnesses are diabetes mellitus, cancer, epilepsy, cerebral
palsy, cardiovascular diseases, arthritis, cleft palate, tuberculosis, and nutritional
disorders.
3. A serious problem exists in getting dental care to the bedfast patient, and
dental societies and community groups can do much to develop programs to meet
this need.
4. Community dental-health programs that lead to the prevention and control
of dental diseases lead also to the prevention and alleviation of chronic illness
and disability.
5. Good dental care is an important factor in contributing to the overall health
and rehbilitation of persons who are chronically ill.
The need for dental care of the long-term patient is not a subject for arbitrary
consideration ; it is a vital requirement in the rehabilitation of millions of per-
sons. Therein lies the role of dentistry in chronic illness — as revealed by the
facts that make up the council's statement.
"Model Welfare House" Opened
Morris County, N. J., has opened a new $1,151,750 "Model Welfare House"
to house and provide care for its poor, chronically ill old men and women.
Located near the top of Shonghum Mountain, the hospital is a 3-story, 138-bed
structure, built in the shape of a Y.
There are direct entrances on the ground level to the admitting room, kitchen,
dining, smoking, recreational and occupational therapy rooms, chapel, morgue,
and laundry. The dining room with a seating capacity of 112, is a half circle
with the exterior wall of glass. The recreation room seats 160 persons and is
adjacent to a large terrace facing the southwest.
On the first floor are 48-bed wards for ambulatory men, two 8-bed and one 6-bed
wards for ambulatory women, and three 2-bed rooms for men or women or cou-
ples. A nurse's station is located in the center of the rotunda to allow efficient
control of administration of the wards.
Bed patients are cared for on the second floor. There are 32 hospital beds for
men and 22 for women, in addition to two 4-bed wards and three 2-bed rooms for
either men or women.
The top floor contains living quarters for the superintendent and 20 employees.
Readers desiring further information on the "Model Welfare House" ai-e
referred to the January issue of The Welfare Reporter, oflBcial publication of the
New Jersey Department of Institutions and Agencies, 135 West Hanover Street,
Trenton.
American Dental Association,
Chicago, III., May 17, 195',.
Hon. Charles A. Wolverton,
House of Representatives,
Washington, D. C.
Dear Congressman : For your information I am enclosing a copy of a special
bulletin which is being distributed by the American Dental Association to its
members. It relates to H. R. 2341.
As you know, this bill proposes that Federal legislation be enacted which
would prevent the fluoridation of community water supplies throughout the
entile Nation. Fluoridation of water supplies is now in operation in near-
ly 1,000 United States cities and towns including Washington, D. C. The resi-
dents of these cities and towns number nearly 17 million.
Fluoridation of water supplies has been demonstrated to be an effective,
safe, and economical measure for the reduction of the incidence of tooth de-
cay, particularly among children.
FLUORIDATION OF WATER 449
In view of the importance of tliis matter the American Dental Association
is asliing its members to advise the Members of Congress on the subject of
fluoridation in general and H. It. 2841 in particular.
With all good wishes.
Very truly yours,
Francis J. Garvey,
Secretary, Council on Legislation.
INFORMATION BULLETIN
To Members of the Dental Profession :
The Wier bill, H. K. l!;J41, which is the subject of this issue of the ADA
Informatioji Bulletin, is a direct attack on the professional opinion of the over-
whelming majority of dentists and physicians who have endorsed and recom-
mended the fluoridation of community water supplies. Because of the impor-
tance of this health measure, it is requested that each member of the dental
profession send immediately his views on the Wier bill, H. R. 2341, to the
Member of Cojigress from his respective district and to the Honorable Charles
A. Wolverton, chairman. Interstate and Foreign Commerce Committee, House
of Representatives, Washington, D. C.
Dentists Urged To Advise Congressmen on Fluoridation As Hearings
Are Called on Bill to Outlavi?^ Procedure
The Committee on Interstate and Foreign Commerce of the United States
House of Representatives has scheduled a public hearing at WashiJigton, D. C,
for May 25, 26 and 27 on a bill which proposes to prohibit the fluoridation of com-
numity water supplies throughout the Nation. The bill was introduced by
Representative Wier (Democrat, Minnesota), of Minneapolis.
The American Dental Association, which has repeatedly endorsed and rec-
ommended that fluoridation of community water supplies as a thoroughly safe,
effective, and economical means of reducing significantly the incidence of tooth
decay throughout the Nation, is strongly opposed to this bill, as are all other
major national-health organizations in the United States.
Members of the health professions are particularly concerned that a com-
mittee of the House of Representatives would at this late date attempt to
bring back into the national political arena a completely nonpolitical issue
which already has been decided by more than 40 years of extensive scientific
research.
The Wier bill itself is quite brief. The heading describes it as "a bill to
protect the public health from the dangers of fluorination [sic] of water." The
text of the bill follows :
Be it enacted hii the Senate and House of Representatives of the United States
of America in Congress assenibled, That no agency of the Government of the
United States (including the government of the District of Columbia, and of
each Territory and pt)Ssessiou of the United States), and no agency of any State,
or of any municipality or other political subdivision of a State, shall treat any
public water supply with any fluoride compound, or make any water so treated
available for general use in any hospital, post office, military installation, or
other installation or institution owned or operated by or on behalf of any such
agency.
Obviously, there are grave doubts as to the constitutionality of this proposed
bill which would have the Federal Government begin making decisions on
health matters for local conununities. There are also reasonable doubts that
the measure, even if amended to meet tests of constitutionality, would ever come
close to passage by either the House of Representatives or the Senate. Since
May 1952, water supplies of the District of Columbia have been fluoridated with
the consent of both Houses of Congress.
The opponents of fluoridation will attempt to utilize the public hearings on
the Wier bill as another sounding board for their oft repeated but totallv un-
founded charges that fluoridation of water is harmful. To the extent" that
these hearings can be used to delay the adoption of fluoridation projects in
communities where they have been reconnnended by local health authorities— to
that extent the whole affair will actually be harmful to the future dental health
of all the children of those communities.
450 FLUORIDATION OF WATER
FLUORIDATION NOW WIDESPREAD
Fluoridation of community water supplies has progressed too widely through-
out the United States (see map on p. 451) and elsewhere throughout the world
to be delayed for long even if Congress did pass the Wier bill or some similar
measure. Just as in local communities where fluoridation has been delayed or
rejected, the setback cannot be considered to be more than temporary.
As of May 1, 1954, controlled amounts of fluoride ions were being added to
water supplies of 944 cities and towns in the United States with a total popu-
lation of nearly 17 million. In addition, approximately 3,500,000 persons re-
sided in communities where the water supplies have contained optiumm amounts
of fluoride ions for generations. Thus, at present, more than 20 million persons,
or about one-fifth of all United States residents served by communal water
supplies, are routinely drinking fluoridated water.
It is, of course, almost inconceivable that the Congress, either as a body or
through one of its committees, would at this time attempt to substitute its
decision on a scientific measure for that of local health otRcials in nearly 1,000
United States cities where fluoridation is in progress, including such metro-
politan centers as Baltimore ; Washington, D. C. ; San Francisco ; Milwaukee ;
Pittsburgh ; Indianapolis ; Louisville ; Miami ; Rochester, N. Y. ; San Diego ; St.
Paul, Minn. ; Providence, R. I. ; Richmond, Va. ; and Youngstown, Ohio.
A PROFESSIONAL RESPONSIBILITY
It is possible that the record at the hearings scheduled before the committee,
headed by Representative Wolverton, (Republican, New Jersey), could be used
to confuse or frighten temporarily the uninformed citizen about fluoridation
as was done with the report of the Delaney committee of the 82d Congress.
For that reason, the American Dental Association is asking all members of the
dental profession to advise their Congressmen immediately about the effective-
ness and safety of the fluoridation of public water supplies and to give their
Congressmen their views on H. R. 2341.
Dr. Leslie M. FitzGerald, president of the American Dental Association, in a
special message to all members of the dental profession, declared :
As professional men it is our duty to advise Members of Congress on fluorida-
tion just as it is our responsibility to advise our patients on the prevention and
treatment of disease. Fluoridation has been proved to be a safe and beneficial
health procedure. The scientific facts are available. They are not going to
be changed by a show of hands of any political group. It is time that the pro-
fession make its voice heard in opposition to this continuing false propaganda
against fluoridation.
The American Dental Association's primary concern is that the hearings on
the Wier bill provide a full opportunity for the presentation of all the scientific
evidence relating to the fluoridation of water as a means of reducing tooth decay,
and for a thorough evaluation by recognized authorities in the field of dentistry,
medicine, biochemistry, and all related areas of science of the statements, re-
ports, and claims presented in testimony before the committee.
Representative Wolverton has announced that during the hearings there will
be equal time given to witnesses who are against and witnesses who are in favor
of the fluoridation of community water supplies.
WHO FAVORS FLUOBIDATION ?
Every major national health organization has gone on record favoring the
fluoridation of community water supplies. A partial list of these organizations
follows :
American Dental Association
Dental societies of all 48 States and the District of Columbia
American Medical Association
United States Public Health Service
American Academy of Pediatrics
Association of State and Territorial Health Ofllcers
American Public Health Association
American Public Welfare Association
Commission on Chronic Illness
National Research Council
FLUORIDATIOK OF WATER
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452 FLUORIDATION OF WATER
American Hospital Associatiou
American Nurses Association
Inter- Associatiou Committee on Health
American Water Works Association
State and Territorial dental directors
American Society of Dentistry for Children
American College of Dentists
Dental section of the American Associatiou for the Advancement of
Science
Various State and county medical societies
Endorsements of fluoridation of water supplies have also been made by nu-
merous groups such as the American Legion, the National Congress of Parent
and Teachers, the United States Junior Chamber of Commerce, and the Con-
gress of Industrial Organizations and by countless millions of individuals inter-
ested in improved dental health for all children.
WHO OPPOSES FLtlORIDATION ?
As could be expected from the foregoing, there is no recognized national health
organization, association, or group on record as opposed to the fluoridation of
community water supplies.
It is true that there are members of the medical, dental and chemical pro-
fessions who are opposed to fluoridation. But they represent only a very tiny
fraction of the total members of these professions. In most instances, these
individuals do not question the effectiveness of the procedure. Instead, they
raise hypothetical objections on the grounds that the addition of fluoride ions
to water supplies might in some way be toxic. Almost without exception, these
individuals have not carried on any actual research in the matter but have
relied upon armchair speculation to develop their hypothetical case against
fluoridation. Gradually, these individuals are accepting the opinions of their
colleagues of the safety of the fluoridation procedure.
By far the larger and more vocal group of opponents of fluoridation are indi-
viduals totally unconcerned with scientific opinion. They are organized in
various communities under such luiidentifiable names as citizens' committee
against fluoridation, pure water committee, etc. Generally, they are engaged
in a rather large traflic of scare pamphlets full of obsolete, irrelevant, and often
totally untrue statements regarding fluoridation. In a recent report on water
fluoridation, the St. Louis Medical Society referred to these charges as ranging
from "Operation Rat Poison to communistic plot themes with a measure of food
faddism for good measure."
In communities where fluoridation has been under public consideration, par-
ticularly those in which there has been a referendum on the matter, the oppo-
sition leaders usually include drugless healers, chiropractors, food faddists,
naturopaths, and those who, for a lack of a better description, could be labeled as
scare pamphleteers. Also often prominent in the antifluoridation groups are
individual members of certain religious groups who are under the erroneous
impression that fluoridation of water supplies is somehow or other a medica-
tion. No national church group has publicly taken a stand against fluoridation.
WHAT ABOUT THE EVIDENCE?
Safety
There is more evidence relating to the safety of the addition of fluoride ions
to water than there is for the addition of any other chemical to any food or
liquid. Since the now-famed research on mottled enamel started more than 40
years ago by Dr. Frederick S. McKay, of Colorado Springs, Colo., and the flrst
epidemiological studies of the relationship between fluorine and dental decay
which were begun in 1931 by Dr. H. Trendley Dean, of Chicago, noted research
scientist and secretary of the Council on Dental Research of the American Dental
Association, several thousand reports on fluorine have been published in the
scientific literature. The Kettering Laboratory at the University of Cincinnati
recently listed more than 5,500 separate references in its Classified Bibliography
of Publications Concerning Fluorine and Its Compounds in Relation to Man,
Animals, and Their Environment, including Effects on Plants. A similar bibliog-
raphy containing nearly 1,400 references was recently compiled by the University
of Rochester for the Atomic Energy Commission.
FLUORIDATION OF WATER 453
The opponents of fluoridation have been quite prolific in recent years in con-
cocting reports of possible ill effects from the addition of fluoride ions to drink-
ing water as recommended by health officials. These included assertions that
fluoridation would : cause or accelerate the growth of cancer ; have harmful
effects on the kidneys, tlii' arteries, and all internal organs; make bones brittle;
aggravate acne and cause a variety of other bodily ills. Each of these asser-
tions, of course, has been very carefully investigated by competent scientists and
each has been thoroughly refuted. Regarding the cancer charge, the president
of the American Cancer Society, Dr. Charles S. Cameron, recently declared :
"The American Cancer Society does not consider fluorine or the common fluo-
rine salts to be carcinogenic. Its position, therefore, with respect to water fluo-
ridation for the purpose of dental caries prophylaxis, is that such treatment of
public water supplies is without danger so far as cancer causation is concerned."
It is only because these luisupported and untruthful charges continue to be
used by the antifluoridation pamphleteers that it is necessary to point out they
are without foundation. Any rational person would assume that fluoridation
of water supplies is safe if it carried the full endorsement of such groups as
the American Medical Association, the American Dental Association, and the
host of health organizations and groups listed above.
For generations, several million persons in the Ignited States have been living
in areas where the drinking water contains fluorides in concentrations as high
as or higher than that recommended as optimal for dental health. Many
studies have been conducted among these people, yet no one has been able to
find any adverse physiological effects except an enamel defect known as mottled
enamel ov dental fluorosis. This condition has been found only in areas where
the water supply contains an excessively high concentration of fluoride ions.
Mottled enamel is not a factor in areas where water supplies contain the rec-
ommended concentration of fluorides.
A significant report on the safety of fluoridated water is the following reso-
lution adopted last Deceml)er without a dissenting vote by the El Paso County
(Colorado Springs, Colo.) Medical Society:
Whereas there is substantial evidence that the water supply of Colorado
Springs has contained a surplus amount (2.6 parts per million) of fluoride for
a period of about 75 years : Be it
Resolved, That during the long practice of medicine in Colorado Springs, it is
the considered opinion of the members of the El Paso County Medical Society that
we have not experienced any clinical symptoms which can be attributed to the
use of such water * * *.
The actual process of adding fluorides to a water supply is no more involved
than adding other chemicals for water purification. These procedures have
been carried on for so many years that they have become standardized; fluori-
dation can be practiced safely by any community that has a public water .sup-
ply system. There are no noticeable effects upon taste, color, odor, or hard-
ness of the water. Nor have any untoward effects been reported by bottlers,
brewers, bakeries, laundries, or chemical plants. No changes in any sewage
treatment processes have been required.
Kr.UORinES STIMT'LATE IMAGTN.\TIVK POWERS
Elyria, Ohio (AP) — Fluorides were to start going into the city water sup-
ply last Thursday, and in the days that followed the water department Avas
flooded with complaints about the taste. The point is, due to a delay in testing,
the fluorides did not go into the water until yesterday. — From the Canton, Ohio,
Repository, April 20. in.'")4.
Effectiveness. — Carefully controlled experiments have shown that children
who drink fluoridated water during the years their teeth are formed will have,
on the average, from 60 to 6:") percent less tooth decay than those of the cor-
re.sponding age groun who live in areas with fluoride-free waters. For example,
in Grand Rapids, Mich., 6-year-old children who had been drinking fluoridated
water sinoe their birth were found to have 70. S percent less tooth decay than
6-year-old children in a nearbv communitv with fluoride-free water. For New-
454
FLUORIDATION OF WATER
burgh, N. Y., where water supplies have been fluoridated since 1945, reductions
of 69.4 and 67.8 percent in the amount of dental decay were reported for chil-
dren in the 6- and 7-year age groups, respectively. (See table below.)
There is virtually no disagreement on the effectiveness of controlled fluorida-
tion in reducing the incidence of dental decay. A particularly significant aspect
of the evidence on this point is the fact that the rate of reduction in tooth decay
from fluoridation has been demonstrated to be approximately the same in ail
parts of the Nation, despite the fact that these tests were conducted by different
investigators under varying climatic and geographical conditions.
Costs. — A third factor of note regarding fluoridation is its cost. Experiences
at various sized water works have shown that the average per capita costs of
the procedure range from 4 to 14 cents per year with the average somewhere
between 9 and 10 cents a year, about the cost of an ice cream cone.
FlKorldafion study projects
Community
Grand Rapids, Mich
Brantford, Ontario, Canada
Newburgh, N. Y
Evanston, 111
Sheboygan, Wis
Date
started
1945
1945
1947
1946
Report
A?e
Reduction
period
group
in decay
(years)
(years)
(percent) '
8
6
70.8
7
52.5
8
49.2
9
48.1
13
39.7
7
6
59.4
7
69.5
8
51.5
9
46.2
13
32.9
7
6
69.4
7
67.8
8
40.4
9
51.4
4
6
73.6
7
56.4
S
.35.4
6
29-10
35.3
12-14
29.7
' Decayed, missing, filled (DMF) permanent teeth.
2 4th grade.
3 Sth grade.
Source: Committee on Dental Health of the Pood and Nutrition Board, National Research Council and
National Academy of Sciences.
RECOMMENDATION OF THE ADA
The safety and effectiveness of fluoridation are summarized in the following
resolution which was adopted unanimously at Cleveland, Ohio, last September
by the 394 members of the house of delegates representing the 80,000 members
of the American Dental Association :
Whereas in 1950 the American Dental Association recommended the fluorida-
tion of public water supplies as a safe and effective procedure for reducing the
incidence of dental caries, and
Whereas this recommendation was based on an accumulation of many years
of careful study and scientific research by competent individuals and groups,
and
Whereas the councils on dental health, dental research and dental therapeutics
of the American Dental Association have continued to evaluate all available evi-
dence relating to the fluoridation of communal water supplies, and
Whereas all additional scientific findings have served to substantiate further
the eft'ectiveuess and safety of fluoridation under properly controlled conditions,
and
Whereas this evidence continues to demonstrate that fluoridation will have
no untoward effect on general health and will significantly improve health
through the reduction of dental decay : Therefore, be it
Resolved, That the American Dental Association reiterate its recommendation
that all local communities be urged to adjust the fiuoride content of their public
water supplies to the level recommended by responsible State and local health
authorities.
FLUORIDATION OF WATER 455
THE OUTLOOK FOB THE FUTURE
Deutal scientists confidently predict tliat within a few years the fluoridation
of community water supplies will be as common throughout the United States as
the chlorination of drinking water and the pasteurization of milk are today.
Fluoridation is being opposed in very much the same manner as were both
chlorination and pasteurization. There was hue and cry that the entire populace
would be poisoned if the deadly gas, chlorine, was added to drinking water. Yet
today, chlorine is as commonplace in community drinking water supplies as are
electric pumps at the waterworks. Pasteurization is likewise accepted as com-
monplace. And for the approximately 20 million United States residents living
in communities where the local water supplies contain fluorides in desirable
amounts, fluoridation is equally accepted.
A COMMUNITY RESPONSIBn.ITY
The American Dental Association believes firmly that the final decision on
fluoridation of community water supplies must be made by each community
on the advice and counsel of local health authorities and the members of the
health professions. This belief stems from the traditional adherence of mem-
bers of the dental profession to the principle of local determination and control
of community health services.
The American Dental Association does not believe that any national group
or agency. Government or private, has any right to dictate to any local com-
munity a decision on a public-health measure such as a fluoridation of community
water supplies. Intrinsically scientific matters cannot be proper subjects for
political debate but must be settled on the basis of reliable and authentic scien-
tific data.
The association believes that the Wier bill, which proposes to deny to all
children the benefits of the fluoridation of water supplies in their home com-
munities, is contrary to the public interest.
Plainfield Dental Society,
Plainfield, N. J., May 24, 195^.
Hon. Charles A. Wolvebton,
Chairman, Interstate and Foreign Commerce Comm,ittee,
House Office Building, Washington, D. C.
My Dear Mr. Wolverton : On May 25, 26, and 27, your committee will hold
hearings on the Wier bill, H. R. 2341.
The Plainfield Dental Society, composed of dentists from parts of Union, Som-
erset, and Middlesex Counties, 4 years ago appointed a committee to investi-
gate the value of fluoridation of communal water supplies. After considerable
deliberation and study of available literature, this committee recommended the
endorsement of fluoridation of communal water supplies as a safe and effective
means of reducing the toll of dental caries in the teeth of children. This society
after discussion at its December 12, 1951, meeting, unanimously passed a reso-
lution urging and approving the fluoridation of communal water supplies, and
recommended that the water supplies of this area be fluoridated. Since that
time, the committee and society have endeavored to present the true picture
of fluoi'idation to the people of this area.
Inasmuch as scientific research has proven overwhelmingly that fluoridation
of communal water "supplies reduces the incidence of dental decay to a great
extent with no deleterious effects, the Plainfield Dental Society, representing
130 dentists from this area, retiuests that you consider the endorsements by the
many responsible health organizations throughout the country and urges the
defeat of this bill.
I am enclosing a copy of an unbiased report by a citizens committee of the
evening department. Village Improvement Association of Cranford, N. J., and
presented to that association in February 19.54.
It is requested that this letter and the enclosed copy of the fluoridation survey
report of Cranford. N. J., be flled for record as part of the hearings.
Very truly yours,
, President.
456 FLUORIDATION OF WATER
FLUOKIDATION SURVEY REPORT (CRANFORD)
This committee has attempted in this paper to present a brief survey of scien-
tific data on the fluoridation of water. Realizing the immensity of such a task,
it humbly hopes that it has achieved some semblance of the same in these dozen
crowded pages. Our appreciation is extended to Dr. Charles Darlington, chief
pathologist at Muhlenberg Hospital, for his advice and generosity in letting us
use his materials and to our health oflicer, Mr. William P. Smith, the other
member of this committee, whose energies in gathering data matched his zeal
and interest in the problem.
Fluorine is a trace element of body composition. It is a natural constituent of
many foods, and of practically all drinking water. It would be almost impossi-
ble to find a diet with no fluorides. The water h^e in Cranford that we drink
has a trace quantity in it. As for the food that we eat, round steak will have
a fluoride content of 1.3 parts per million, cheese 1.6, rye bread 5.3. butter 1.5,
fresh fish 1.6 to 7, canned salmon 8.5 to 8, and tea (dry analysis) 30 to 60 parts
per million. The daily intake of fluorides has been estimated to be 0.19 to 0.32
milligrams. This fact seems to clearly establish that the fluoride ion is not
foreign to our diet and existence, despite its well-known toxicity in high con-
centrations.
ORIGIN OF THE FLUORIDATION THEORY
Although drinking water is considered the most universal carrier of the fluoride
ion, the quantity of calcium fluoride found dissolved in it seems to be a matter
of geographic identity. Some areas, such as ours, receive very little, while other
areas of the world, including our great Southwest, receive considerable amounts.
High concentrations of calcium fluoride in some of these southwestern towns
was found in 1931 by H. V. Churchill, chief chemist of Alcoa, and also by Mar-
garet C. Smith and H. Y. Smith of the University of Arizona to be responsible
for the mottled teeth of the people. It was also discovered that associated with
the mottling was a greater resistance to tooth decay or dental caries.
This observation led the way for the work of Dr. H. Trendley Dean, Dr. Fred-
erick S. McDay, Dr. F. A. Arnold, Dr. F. J. McClure, and many other research
men. Theory became fact. There was no doubt but that it was the fluoride ion
that in some way affected the structure of the teeth themselves. Dr. McKay
states that, "It might be said that for the first time a new and different kind
of tooth structure is being dealt with which has the property of resisting the
initial caries attack. When caries occurs it is practically limited to the fissures
and pits. Caries of the pi-oximal surfaces of the anterior teeth is almost negli-
gible." In order to obtain this resistance to decay a child must have an ade-
quate fluoride intake during the calcification of the teeth from birth to the
12th year.
CLINICAL AND EXPERIMENTAL EVIDENCE
Experiments and studies of the effect of fluorides have been carried on for
the past 20 years. About 5,000 titles of scientific articles bearing on the physio-
logical effects of fluorides appear on the list which was compiled at the Kettering
Laboratory at the University of Cincinnati School of Medicine.
Dr. H. Trendley Dean, director of the National Institute of Dental Research,
showed in hi^epidemiological investigations of 7,257 children aged 12 to 14 that
the prevalence of dental caries (decay) was greatest in those children who had
drunk from birth water containing no fluorides. The prevalence of decay was
progressively less in children reared in cities with public \^ater supplies having
a fluoride content up to approximately 1 part per million.^ Beyond this concen-
tration there was little, if any, advantage. The children reared in cities where
water contained approximately 1.0 part per million showed about one-third as
much dental decay as those children reared in cities with fluoride-free water.
These observations have been confirmed many times. ^
Considerable work has been done by Dr. Dean and othier research men toward
determining what is known as optimum level of fluoride or threshold value,
that is, that concentration of fluoride per million parts of water which will
bring about the desired resistance to dental decay with mottling limited to less
than 10 percent of the children. This mottling should not be visible except to
the trained eye of the dentist. It was found that a concentration of approxi-
mately 1.0 parts per million fluoride would produce these results. However,
climatic conditions are a factor to be considered, as the warmer the climate the
more water is consumed. jFor example, in the Chicago area where the mean
FLUORIDATION OF WATER 457
auuual temperature is 49° F., a 1.0 to 1.5 parts per million fluoride concentra-
tion was recommended, whereas in Georgia with a mean annual temperature of
68° F., the threshold value was found to be 0..5 to 0.7 parts per million. The
amount recommended for Cranford would probably be about 1.0 part per million.
These limits are set sufficiently low so that no harmful effects will result. This
is pointed out by a statement of the ad hoc committee on fluoridation, which was
convened by the National Research Council to review the evidence and prepare
an impartial report. Their report states that, "The margin between the optimal
(juantity of fluoride in drinking water which is required for maximal benefit in
tooth development and the amount which produces undesirable physiological
effects is sufficiently wide to cause no concern."
STUDIES OF THE PHYSIOLOGICAL EFFECTS OF FLUORIDES
Scientists feel that the most sensitive indication of a fluorosis is the mottling
of teeth. Keeping the concentration of fluoride below that which is required to
give a definite mottling is agreed to be a safe margin. Studies have been made
on persons who for all their lives have been drinking water with much higher
than recommended concentrations of fluoride. Since the intake of fluoride
results in a pronounced increase in the fluorine content of the teeth and bones,
most investigations include X-ray examinations. In such a survey conducted by
Dr. Dean at Bartlett, Tex., where the water contains 8 parts per million fluo-
ride, 11 percent of the people did .show an increased bone density, but there was
no funcfioaal impairment. Moreover, there was no evidence of skeletal fluorosis
in similar tests conducted on persons who have been drinking water containing
1.2 to 8 parts per million of fluoride. (Hodges and others, 1941). It has been
estimated that from the average adult consumption of drinking water (1%
quarts) there would be an intake of approximately 1.6 milligrams of fluorine
of the water had a fluoride content of 1.0 part per million. This 1.6 milligrams
compares with the 3.0 to 4.0 milligrams Dr. McClure in his fluorine balance
studies has slv)wn that the body can handle efficiently through elimination.
Dr. McClure states that, "The results of fluorine balance studies are interpreted
as being strongly indicative that quantities of fluorine up to 3.0 to 4.0 milli-
grams ingested daily are perhaps more than 90 percent eliminated by the aver-
age adult." Greater quantities of fluoride than that mentioned above have been
handled efficiently by the body. Studies were made on a 63-year-old man and his
57-year-old wife, who for the greater part of their lives have lived in Bartlett,
Tex., where the water contained 8 parts per million of natural fluorides. Their
daily intake of fluorides was to be 15.3 milligrams, most of which was eliminated.
Neither of these persons showed any changes in bone tissue or any functional
impairment of any kind.
Dr. Francis F. Hayroth in his paper Toxicological Evidence for the Safety
of the Fluoridation of Public Water Supplies states that, "Epidemiologic data
nn<l clinicnl :ind riidioun-ajthic examiiiati<n]s of exposed industrial workers indicate
that only when the fluoride content of a water supply exceeds 5 or 6 parts per
million will its prolonged usage give rise to detectable osseous (bone) changes
and then only in the most susceptible persons." Dr. Hayroth further states that,
"Our metabolic data have shown that when calcium fluoride is taken in solu-
tion the fluoride ion derived from it behaves as does that from sodium fluoride."
In other words, a fluoride ion is a fluoride ion whether its chemical source be
sodium fluoride as used in fluoridation or calcium fluoride which is assumed to be
the chemical source for the fluoride ion found present in drinking water.
Studies of bone fracture data of high-school boys and young adult Army
selectees fi-om flncricle and nonfluoride areas indicate no difference in the number
of bones fractured. No evidence could be found that bones from fluoride areas
were more brittle. In fact. Dr. L. B. Barnett of Hereford, Tex., has this to say
about a group of hip-fracture patients whose average age was 82 and who it was
estimated consiuned 2.O.") milligrams of calcium fluoride daily, "X-rays of the
bones and hip joints of these old people resemble those which we see in young
adults. None of the patients died of the fractures of the hip and all united."
The average healing time was 8 weeks.
Careful analysis of mortality and morbidity statistics of various parts of the
country show no significant differences between fluoride and nonfluoride areas.
At this time. 3i/^ million people in 44 States are drinking, and have been drink-
ing for many years, water with a natural fluoride content of 0.7 to 2 parts per
million. It is felt that had they been adversely affected there would be some
indication by this time. No doctor or any research man has been able to find
any such evidence.
458 FLUORIDATION OF WATER
FLUOEIDATION PE0JECT8
Results of fluoridation projects begun in 1945 are more and more indicative of
the similarity of protection offered by fluoridated water and water containing
enough of the natural fluoride. In May 1945 sodium fluoride was added to the
Newburgh, N. Y., water supply to increase the fluoride content to 1.2 parts per
million. Kingston, N. Y., with almost no fluoride in its water supply, was kept
as the control city. After 6^/^ years of fluoride experience, the decay ed-missiag-
ftlled rate (DMF) of children at Newburgh was half that of Kingston. Five
hundred children in each city are also given complete physical examinations
annually, as well as dental examinations. These include blood counts, X-ray
studies of the hands, forearms, and legs, and routine urinalysis. Except for their
greater resistance to tooth decay there is no evidence that the children of New-
burgh are any different from the children of Kingston.
Other fluoridation programs at Grand Rapids, Mich. ; Sheboygan, Wis. ;
Marshall, Tex. ; and other cities are bringing similar results. The American
Dental Association (Fluoridation, January 19.53) states: "Studies begun in 1945
indicate that a similar degree of protection against dental caries is found in areas
where fluoride content has been adjusted to an optimum level as is found in areas
where the same concentrations occur naturally." The engineering involved in
these progi-ams is simple, and the cost, while it varies from city to city, is low.
ENDORSEMENT OP FLUOEIDATION
"No public health program at the time of introduction ever had as much
scientific data based on human experience as is now possessed in the fluoridation
program."
The American Medical Association has given approval both with respect to
the safety and desirability of fluoridating water supplies.
Fluoridation of public water supplies has been endorsed by the American
Water Works Association, American Dental Society, the United States Public
Health Service, the American Public Health Association, the Inter-Association
Committee on Health, and others.
CEITICISM OF FLUOEIDATION
Criticism of fluoridation stems from several sources. There is a small group
of scientists who feel that all is not known about the physiological effects of
fluoride nor wull it ever be known. They agree that all the data presently avail-
able make fluoridation appear safe and desirable but feel that more information
should be obtained. This type of argument is of an entirely different caliber
than those found in sensational articles written in a deliberate attempt to smear
and discredit fluoridation research. Without references to experiment or expe-
rience there are wild claims that fluoride in water will be responsible for any-
thing from appendicitis, diabetes, sterility, mental retardation, to nephritis and
cancer and other things. They call it rat poison and list the symptoms of acute
fluoride poisoning which is an entirely different matter.
Occasionally, one finds a reference to an experiment on cancer in rats, but
no one bothers to mention that the results were retracted by a very embarrassed
University of Texas when it was found that all the rats had come from a strain
highly inbred for cancer and that fluoride had no bearing on the matter.
There are some "food faddists" who object to the procedure and feel that
perhaps the solution lies in obtaining the additional fluoride from a daily "bone
meal cocktail."
You might happen to see antifluoridation literature published by the Citizens
Medical Reference Bureau, Inc., which is staffed by a man claiming no medical
affiliation and whose main function seems to be the opposition of vaccination
for school children.
One of the wildest and vilest accusations which this committee has found
among some of this "literature" is the assertion that those who desire fluorida-
tion are Communist inspired.
Considerable references have been made to. the investigations carried out by
the Delaney Committee and the statements made by Representative A. L. Miller.
Any examinations of the proceedings will show a definite predisposition on the
part of the committee which was reflected in their questioning of the 18 wit-
nesses. They seemed to accept as fact the personal opinions of the seven
witnesses who opposed fluoridation and who had done no recent experiments
themselves. The 11 who represented major medical, dental, and health groups
FLUORIDATION OF WATER 459
were cross-examined in detail on the data ttiey had brought with them. J. Roy
Doty, secretary, council on dental therapeutics, American Dental Association, in
his analysis of the Delaney Committee report on the fluoridation of drinking
water has this to say :
"It is our opinion that the congressional committee report suffers from a lack
of adherence to the proper standards of investigative procedures as evidenced
especially by its failure to substantiate many statements which it accepted as
fact. The committee also accepted misgivings of a few individuals who appeared
as witnesses, in spite of the weight of the evidence furnished by such organiza-
tions as the American Dental Association, the American Medical Association,
the United States Public Health Service, the National Research Council, the
American Public Health Association, and the Association of State and Terri-
torial Health Officers. The committee, through its statement that "dental decay
is not contagious nor can it be said to constitute a serious danger to health,"
implies that a disease is not a community problem unless it is contagious and
fails to recognize the fact that dental caries is the most prevalent disease of
mankind.
"In our opinion, the evidence to demonstrate the safety of the fluoridation
procedure is so overwhelming that there is no justification for further denying
to large numbers of children the benefits of better dental health which will
result from this procedure."
SUMMAB"?
1. We feel that it has been established that the fluoridation is not foreign
to our existence since it is a trace constituent of teeth and bones and naturally
occurs to some degree in water and a great many foods.
\ 2. The committee feels that it has been established that the adjustment of
flaoride to an optimum level of approximately one part per million will reduce
™;ntal decay of children in a fluoride-free community up to 60 percent.
/ 3. The committee feels that there is considerable evidence justifying the
safety of a fluoride content of one part per million. Attesting to this safety
are the 3% million people who for many years have been drinking fluoridated
water.
4. The committee feels fully satisfied that the committee of the American
Dental Association and the American Medical Association who critically re-
viewed the research data did not act hastily aiud would not have endorsed
fluoridation had there been any reasonable doubts.
5. The committee urges the members of its community to be of an inquisi-
tive mind and ask the "why and wherefore" when confronted with fantastic
tales of what fluoridation will do. We urge you to differentiate them into fact,
fear, and fiction.
Miriam P. Moody,
Chairman, Fluoridation Survey Committee.
American Medical Association,
Chicago, III., May 10, 195Ji.
Hon. Charles A. Wolverton,
Chairman, Committee on Interstate and Foreign Commerce,
House of Representatives, Washington, D. C.
Dear Sir: I would like to take this opportunity, on behalf of the American
Medical Association, to submit for your consideration the views of the Amer-
ican Medical Association concerning the fluoridation of drinking water, which
we understand is included among those suljjects currently being studied by your
committee and which will be the subject of hearings later this month.
The councils on pharmacy and chemistry and foods and nutrition of the Amer-
ican Medical Association made a careful study of all available data with re-
spect to the ingestion of fiuorides in drinking water under natural conditions
and when fluorides are added. On the basis of this study, the councils on phar-
macy and chemistry and foods and nutrition adopted the following statement
on November 2, 1951 :
"The council on pharmacy and chemistry and the council on foods and nutri-
tion have been requested to state their opinion regarding the safety of fluorida-
tion of water supplies, a procedure which has now been adopted by more than
140 cities.
48391—54 30
460 FLUORIDATION OF WATER
"The councils are unaware of any evidence that fluoridation of community
water supplies up to a concentration of one part per million would lead to
structural changes in the bones or to an increase in the incidence of fractures.
The only diflJculty so far revealed is a possible increase in mottling of the tooth
enamel. The available evidence based on thousa.nds of observations indicates
that the incidence of mottling of the enamel in children who drink water con-
taining fluoride up to a concentratioai of one part in a million is minimal and
detectiible only by careful dental examination. It occurs only in a small per-
centage of children and is so slight as not to present a problem from the point
of view of appearance or strength of the teeth. Evidence of toxicity other than
the effect on enamel has not been reported in communities where the water sup-
ply has several times this concenti'ation. After considering the evidence avail-
able at this time, the councils believe that the use of drinking water contain-
ing up to one part per million of fluoride is safe. However, the use of prod-
ucts which are naturally high in fluoride content, such as bonemeal tablets,
or of lozenges, dentifrices, or chewing gum, to which fluoride has been added,
should be avoided where the drinking water has been fluoridated. In places
where children are subjected to warm temperatures and consequently drink large
amounts of water, a lower concentration of fluoride may be necessary to avoid
mottling of the teeth."
The councils purposely refrained from making any recommendation that
communities support or oppose projects for the fluoridation of water supplies.
It was the opinion of the councils that this question should be answered by the
dental profession.
The house of delegates of the American Medical Association at its meeting
in Los Angeles, Calif., December 4 to 7, 1951, adopted the following resolution :
"Whereas carefully controlled studies have demonstrated that fluoridation of
water supply has been definitely beneficial in the reduction of dental caries in
the younger age group ; and
"Whereas the Council on Pharmacy and Chemistry has reported that fluoride
is nontoxic in community water supplies up to one part per million ; and
"Whereas the addition of fluoride to community water supplies seems to have
merit : Therefore be it
"Resolved. That the house of delegates of the American Medical Association
endorse the principle of fluoridation of community water supplies."
The house of delegates of the association went a step further than the councils
in endorsing the principle of fluoridation. Again, however, the house of dele-
gates did not urge or recommend that any communities undertake to fluoridate
their water supplies.
In summary, then, the American Medical Association in 1951, through its
councils on pharmacy and chemistry and foods and nutrition and house of dele-
gates, reached the following conclusion with respect to fluoridation : Fluori-
dation of public water supplies in a concentration not exceeding one part per
million is nontoxic and its principle is endorsed. The position of the association
has not changed since that time.
It is requested that this letter be made a part of the record of the hearings
to be conducted by your committee on this subject.
Sincerely,
George F. Lull, M. D.,
Secretary and General Manager.
Congress of Industriai- Organizations,
Washington 6, D. C, May S-'t, 1954.
Congressman Charles A. Wolverton,
Chairman. Interstate and Foreirm Commerce Committee,
House Office Building, WasJiington, D. G.
Dear Mr. Wolverton : I understand that you are holding hearings on the
matter of adding fluoride to public water supplies. You may be interested in
knowing that the CIO executive board at a meeting this March, approved the
report of the CIO social security committee endorsing fluoridation of drinking
water. We believe this step is a constructive one in preventing dental decay.
We should appreciate having this letter included as part of your committee
record.
Sincerely yours,
Katherine Pollak Ellickson.
Executive Secretary, CIO Social Security Committee.
FLUORIDATION OF WATER 461
UNIVERSITY OF KLOKIDA
Gai.nksville, J/«// il, 1954
Hon. Charles A. Wolverton.
Chairman, Committee oh Interstate and Foreifjn Connneree,
House of Representatives, Washiyiijton 25, I). C.
Dear Sir : My name is A. P. Black. I have the honor to px-esent to your com-
mittee comments in opposition to tlie enactment of H. R. 2341 (Wier) "to protect
the public liealth from the dangers of fluoridation of water."
Following' tlie receipt of an undergraduate degi'ee 1 accomplished graduate
work at Harvard University and at the University of Iowa and hold the doctor
of philosophy degree from the latter institution. I have been a member of the
staff of the department of chemistry of the University of Florida since 1919
and head professor .since 1949. I have for many yeai-s been active in the held
of water chemistry and have conducted intensive investigations on the presence
of fluorides in natural waters. In 19?>(> I made a survey of the fluoride content
of the public water supplies of the State of Florida — one of the flrst, if not the
first, State survey to be made in this counti-y. In the same year I was made
chairman of a committee of the American Water Works As.sociation on methods
of determining fluorides. After 4 years of work, that committee in 1941 made
its report and the recommeded method has been in use in this country and abroad
since that time. In 1949 I was chairman of the American Water Works As.socia-
tion committee on the fluoridation of public water supplies. The report of this
committee was adopted as the oflScial policy of the American Water Works Asso-
ciation and. as such, was the first .statement of policy to be adopted by any national
organization. I have made moi'e than itO addresses on fiuoridation to professional
and scientific groups throughout the country, and am the author of numerous
papers on fluoridation. My views with respect to fluoridation are fully set forth
in a monograph which I have wi'itten and which is entitled "Some Facts Con-
cerning Fluoridation." A copy of that monograph, together with copies of other
reprints referred to above, are presented as part of this statement and it is
requested that they, togeHier with this statement, be inserted in the record.
I should like to confine my comments in this statement to three specific points :
1. The Department of Health, Education, and Welfare is char,ged with the
responsibility of protecting the health of the American people. The United States
Public Health Service, an agency of that Department, has approved the fluorida-
tion of public water supplies ; lias set up machinery to publicize the beneficial
effects of the procedure and to assist the various States in implementing fluorida-
tion programs ; and has established in its drinking water standards a maximum
l)erniissible limit of U5 parts per million of the fluoride ion.
The Food and Drug Administration is charged with the responsibility of seeing
to it that foods (including water) distributed in interstate commerce shall not
contain any substance deleterious to health. This Administration issued on
July 17, 1952, and published in the Federal Register on July 23, 1952, a statement
of policy designated S-327 which contains the following statement :
"The Federal Security Agency will regard water supplies containing fluorine
within the limits recommended by the Public Health Service as not actionable
under the Federal Food, Drug, and Cosmetic Act."
If, after hearing the evidence presented to you by individuals who by virtue
of training and experience have shown themselves to be competent to testify with
authority, the committee feel that the practice of fluoridation requires further
investigation, then it would appear that the proper course of action would be
to refer it back to these agencies of the Federal Government charged with that
responsibility.
2. I should like to refute the statement so often made by the opponents of
fluoridation that fluorides naturally present in water are not identical with, and
would not be expected to behave in a manner similar to, fluorides added to \v;;ter.
The statement is not true for the following reasons :
(a) Most salts, including the salts of fluorine which occur in water or
which are added to water for the reduction of caries, dissociate into posi-
tively and negatively charged ions. The salts themselves are. therefore, not
pre.sent in the water hut only the ions resulting from their dissociation. In
the case of naturally present fluorides in water and in the case of fluorides
added to water, the.se ions are identical, and it is not logical to suppose that
the same ions in water would produce different effects depending whether
they were naturally present or have been added.
462 FLUORIDATION OF WATER
(&) The chemical methods for determining fluorides in water work
equally well in the case of fluorides already present or in the case of fluo-
rides added to the water. As a matter of fact, there is no known method
of differentiation, physically or chemically, between fluorides naturally pres-
ent and fluorides added.
(c) The effects of natural fluorides and added fluorides in reducing dental
caries are identical for the same concentration. This has been conclusively
shown by comparison of the Grand Rapids and Newburgh data with data
from the same age groups at Aurora, 111., where fluorides are naturally
present. The same conclusions have been reached in numerous other studies
conducted throughout the country.
3. I oppose the proposed legislation as improper since decisions with respect
to such matters should be left to State and local authorities. I would, with equal
vigor, and for the same reason, resist the passage of legislation to require the
fluoridation of all public water supplies.
The fluoridation of public water supplies for the reduction of dental caries
is one of the great advances in public health, not only of this generation, but of
this century. The attention of your committee is respectfully called to the fact
that other great advances in public health have been misunderstood and have
often met with strong opposition. The monumental work of Louis Pasteur was
ridiculed for many years, yet it stands today as a landmark in man's fight against
disease.
I express to you the hope that your committee, in considering the statements
which are presented to you, will apply to them the rigid criteria which all good
scientific work must meet and will in your wisdom, base your conclusions upon
the evidence thus assembled.
Respectfully submitted.
A. P. Black,
Head, Department of Chemistry, University of Florida, Gainesville, Fla.
The following papers and monograph written by A. P. Black are submitted
as part of this statement with the request that they be made a part of the
record :
(Filed with the committee for appropriate consideration.)
1. Fluorine in Florida Waters. Pages 5-9. Proceedings of the 11th Annual
Convention of the Florida Section, American Water Works Association (1937).
2. Methods of Determining Fluorides. Committee report, reprinted from the
Journal of the American Water Woi-ks Association, volume 33, No. 11, Novem-
ber 1941.
3. The Fluoridation of Public Water Supplies. A statement of recommended
policy and procedure, reprinted from the Journal of the American Water Works
Association, July 1949.
4. The Chemist Looks at Fluoridation. Pages 137-144. Journal of the Ameri-
can Dental Association, February 1952.
5. Some Facts Concerning Fluoridation. A monograph prepared for the
Georgia Department of Public Health and the Georgia Dental Association, and
now being reprinted by the Georgia and South Carolina Departments of Health.
The Johns Hopkins Unh-eesity,
School of Hygiene and Public Health,
Baltimore, Md., May 21i, 195-^.
Hon. Charles A. Wolverton,
Chairman, Committee on Interstate and Foreign Commerce,
House of Representatives, Washington, D. C.
Dear Mr. Wolverton : I have been apprised that your committee will hold
hearings on May 25, 26 and 27, 1954 on H. R. 2341 a bill to protect the public
health from the dangers of fluorination of water. On account of physical dis-
ability, I am unable to appear before the committee but I would like to express
my opposition to the enactment of this bill. I believe that the passage of such
legislation would be unwise and detrimental to the interests of public health
of many communities of the United States. Evidence of the value of this pro-
cedure in the partial prevention of dental caries is convincing. On the other
hand, there is no acceptable evidence that the addition of fluorides in proper
dosage of trace amounts to a water supply deficient in this element is in any
way detrimental to the physiological well-being of consumers, sick or well, young
FLUORIDATION OF WATER 463
or aged. The danger is purely hypothetical. Fluoridation of water appears
at present to be the only effective procedure for large-scale control of dental
caries in urban population groups. This judgment is based upon a critical re-
view of the literature on this subject undertaken first as chairman of the Ad
Hoc Committee on Fluoridation of Water Supplies for the National Research
Council and, later, as chairman of a committee created by the Chronic Disease
Commission. Copies of these reports are attached herewith, together with an
abstract of my educational and personal qualifications taken from American
Men in Science.
I respectfully request that my statement be made a part of the record of the
hearing, together with the attached documents.
Very truly yours,
Kenneth M. Maxcy, M. D.,
Professor of Epidemiology.
[From American Men of Science, 1949]
Maxcy, Dr. Kenneth F(uller) : School of Hygiene and Public Health, Johns
Hopkins University, Baltimore 5, Md. Epidemiology. Saco, Maine, July 27, 89 ;
m. 18 ; c. 3. A. B., George Washington, 11 : M. D., Hopkins, 15, Rockefeller Foun-
dation fellow, 19-21, Dr. P. H. (epidemiol.), 21. Res. house officer, Hopkins
Hosp., 15-16, asst. res. pediatrician, 16-17 ; asst. internal med., Henry Ford Hosp.,
17-19 ; from asst. surgeon to surgeon, U. S. Pub. Health Service, 21-29 : prof. prev.
med. and bacter., Virginia, 29-36; prev. med. and pub. health and head dept.,
Minnesota, 36-37 ; prof, bacter., Sch. Hygiene and Pub. Health. Hopkins, 37-38,
epidemiol., 38- , director. Poliomyelitis Research Center. Sci. director, int.
health div.. Rockefeller Foundation, 37-40, 42-45, 48. Ed. board, "Am. Jour.
Hygiene," Mem. cmt. sanit. eng., div. med. sciences, Nat. Research Council ; mem.
med. advisory cmt., Nat. Foundation Infantile Paralysis ; mem. exec, cmt., ad-
visory board health services, Am. Red Cross. Consultant, Sec'y War, board
invest, epidemic diseases. U. S. A. A. A. ; fel. Pub. Health Assn ; Assn. Physi-
cians : Soc. Epidemiol. Infectioiis diseases and public health ; malaria and typhus
epidemiology ; quinine in the treatment of malaria ; endemic typhus in the south-
ern United States ; scrub typhus in New Guinea ; poliomyelitis.
[Reprinted from and copyrighted as part of Journal American Water Works Association,
vol. 44, No. 1, January 1952]
National Research Council Viewpoint on Fi.uoridation
AD HOC committee REPORT
Report of the Ad Hoc Committee on Fluoridation of Water Supplies, Division of
Medical Sciences, National Research Council, Washington, D. C.
The Ad Hoc Committee on Fluoridation of Water Supplies was convened and
directed to express its judgment whether, on a basis of a review of the present
status of scientific knowledge, supplementing the fluoride content of public water
supplies for the partial prevention of dental caries is a desirable and safe pro-
cedure from a physiological viewpoint. Specifically, it has been advocated that,
if necessary because of the deficiency of this element, the fiuoride content of the
public water supplies be adjusted to insure a mean content of approximately
1 part per million of fluorine. While some aspects of water fluoridation are still
in the experimental stage, its application has been shown to be technologically
practical and economically feasible. However, it remains to be determined by
each municipality contemplating installation of this procedure: ia) What bene-
fits may be expected, and (6) what the potential liabilities are. After reviewing
the available evidence, the committee concluded that the following are the prin-
cipal considerations, briefly stated, upon which judgment must be based :
1. Under normal conditions of living, fluorine is a trace element in human nutri-
tion (1). Minute amounts are absorbed from certain foods and drinking water
and, to a limited extent, are retained by dental and osseous tissues. The quan-
tity of fluorine ingested in food is a relatively unimportant variable : the average
diet contains 0.2 to 0.3 milligram daily. Of greater importance is the variable
quantity ingested in drinking water. Many of the public water supplies in the
United States, particularly those of the large citie.s, which are derived from
rivers, lakes, and ponds, are practically fluoride-free ; others contain from
traces to 1.5 parts per million fluorine as fluorides. A number of supplies, par-
464 FLUORIDATION OF WATER
ticularly those obtained from deep wells and aquifers irregularly distributed in
various parts of the country, contain from 1.5 parts per million to 7 or 8 parts
per million — very rarely more (2) .
2. From the epidemiological investigations of Dean (3), there is convincing
evidence that, within certain limits, there is an inverse relationship between
the natural fluoride content of drinking water and the frequency of dental caries
in children who depend upon these supplies. The most useful index of the
amount of caries is the number of decayed, missing, and filled permanent teeth
(DMF) i)er child, per 100 children, or per 100 permanent teeth, at specified ages.
Dean's original observations were based upon 7.2.57 selected white school chil-
dren aged 12 to 14 in 21 cities of 4 States. The prevalence of caries (DMF)
was greatest in those children who had used continuously from birth the public
water supplies which were flnoride-free. The prevalence was progressively less
in comparable children reared in cities with public water supplies having a fluo-
ride content up to approximately 1 part per million. Beyond this cnucentration
there was little, if any, advantage. Children reared in cities where drinking
water contained approximately 1 part per million of fluoride experienced only
f;ppi'oxiniately one-third as much dental cariei-^ as those reared in cities where
water supplies wei'e fluoride-free (4). These basic observations have been con-
firmed and extended by investigators in this and other countries.
3. The caries-preventive effect of adequate fluoride intake is princiitally con-
ferred upon children when the dentine and enamel of the permanent dentition are
being formed : that is, from birth to approximately the 12th year. There is
evidence that this increased resistance to dental caries is carried over to some
extent into later life, so that there is a delay of at least several years in the inci-
dence of caries (5). A recent detailed epidemiological study of adult popula-
tions considerably extends knowledge in this field (6). These observations show
that marked caries-inhibitory effects of fluoride waters are operative in the
35 to 39- and 40 to 44-year-old groups.
4. A considerable number of experimental studies have been conducted in the
laboratory to explore the inhibition by fluorides of induced experimental caries in
rats and hamsters, and to explain this action. The results give consistent sup-
port to the concept of a relationship between human caries and fluorides (1).
Although it appears probable that caries resistance is associated with the in-
corporation of fluorides into the tooth structure, the exact mechanism by which
it is mediated is unknown. The causes of caries are only partially understood.
5. The margin between the optimal quantity of fluoride in drinking water that
is required for maximal benefit in tooth development and the amount that pro-
duces undesirable physiological effects is sufficiently wide to be of no concern.
The most sensitive indication of the latter amount is the enamel defect of the
permanent teeth known as endemic fluorosis, or mottled enamel. The epidemi-
ological studies of Dean (T), which were based upon examination of 5.824 white
children in 10 States, showed a direct correlation between severity of the mani-
festations of mottled enamel and the increasing fluoride content (up to 5 parts
per million) of the water suj, plies upon which the children were dependent. At
approximately 1 part per million, less than 10 percent of children show the least
detectable evidence of disturbances in enamel formation, which are not visible
excet to the trained eye of the examining dentist. Beginning at approximately
2 parts per million, an increasing proportion of children have mottled enamel of
a grade that is easily apparent. Although such teeth are caries-resistant, they
are esthetically objectionable.
6. Although the safe level of fluoride concentration to afford a maximum caries-
preventive effect without mottled enamel is approximately 1 part per million, this
level varies somewhat with climatic and other factors and must be ascertained for
each general area (8). For practical public health purposes, it has been pro-
posed that a safe level has been renched when not more than 10 to 15 percent
of children aeed 12 to 14 who have used water supplies since birth, and who
have been examined under stnndard conditions, show the mildest detectable
type of mottled enamel. Under the clnnatological conditions prevailing in
the Chicago area, where the mean annual temperature is approximately 40° F.,
this upper limit ha.s been reached by domestic water supplies containing approxi-
mately 1.0 to 1.5 parts per million fluoride. On the other hnnd, in the vicinity
of Moultrie or Brunswick, Ca.. with a mean annual temperature of (58° F.,
the upper level has been found to be associated with water supplies containing
only 0.5 to 0.7 parts per million.
7. There is an extensive literature on the phnrmacology and toxicology of
fluorine and its compounds. This field hns been reviewed by several .nuthors
(9-12) . Only those parts of it which deal with the cumulative action of fluorides
FLUORIDATION OF WATER
465
Chronic fluoride
the
dusts
ides
las
but
hppn renorted to li;ive ijiven rise u' n nuiuMt-i wi. ^«oco ^. ^ — ;," ^. ' ^
the reported data are inadequate t.. establish the thresh<.ld -'fentration at
which storage mav be expected to occur to a potentially hariutul extent. A
radiologic survey at Bartlett, Tex.,' where the water contains 8 parts per mil-
lion revealed an increased bone density not associated with functional impaii-
nien't in 11 percent of those examined, but roentgenologic examinations of a
limited number of peivsons living in areas where the water contained from 1.2
to 8 0 parts per million, revealed no evidence of fluorosis (14).
The fluoride concentrations in the urine of normal teen-age boys and young
men closelv approximate those in their drinking water in regions where the
water supplies contain from 0.2 to 4.7 parts per million (9). Flourine-balance
studies furnish additional evidence that the human body eliminates the ma.ior
portion of food- and water-borne fluoride when the quantities ingested do not
exceed 4.0 to 5.0 milligrams of fluoride daily (1), although the daily Ingestion
of 6.0 milligrams led to demonstrable storage (15 ) .
In the accumulated experience, there is no evidence that the prolonged in-
gestion of drinking water witli a mean concentration of fluorides below the level
causing mottled enamel would have adverse physiological effects. As the water
supi)lies in various parts of the country contain considerably greater amounts,
it is desirable that epidemiologic surveys of the incidence of chronic fluorosis
be made in those regions, and that further balance studies be undertaken in order
to establish the facts about storage of fluoride at moderately elevated levels of
intake.
8. In 1945 studies were begun to ascertain whether the ad.1ustnient of the
fluoride content of a public water supply to the optimal level with commercially
available fluorides would confer the same caries-inhibitory effects as do waters
which carry the same concentrations of fluoride naturally.
Preliminary analysis of the first 4 years is now available on two studies
in which the observations were carefully controlled: (o) the Grand Ilapids-Mus-
kegon-Aurora study (16). and (b) the Xewburgh-Kingston study (17, 18).
Beginning in January 1945, sodium fluoride was added to the Grand Rapids,
Mich., water supply in sufficient quantities to insure continuous maintenance
of a level of approximately 1 part per million. In order to establish a base
line of dental caries experience prior to fluoridation, 19,680 children with history
of continuous residence in Grand Rapids were given a complete dental examina-
tion. In addition, 4,291 children were examined in Muskegon, Mich., a city
which derives its fluoride-free water supply from the same sources as does Grand
Rapids — from Lake Michigan. An additional 5,116 children were examined in
Aurora, 111., where the community water has for years contained 1.2 parts per
miUion of natural fluoride. Data from examinations conducted at Grand Rapids
and Muskegon during the autumn of each year since 1945 (that is, five yearly
examinations since fluoridation was begun) have been tabulated. These exami-
nations were made on representative children from the kindergarten, first, fourth,
eighth, and eleventh school grades. In Grand Rapids, there has been a reduc-
tion in caries experience in the permanent teeth of children examined in 1949,
particularly in the younger age groups, from the rate expected on the basis
of the 1944 45 examinations. The apparent amount of reduction in the decayed-
mottled-filled rate per child at ages 6, 9, 13, and 15 years, was approximately
51, 36. 17, and 12 percent, respectively. Concurrently, there has been a slight
decline in the caries rates reported by Muskegon with its fluoride-free water
supply but it is relatively small and inconsistent : 22 percent in the 6-year-olds
and 28 percent in the 7-year-olds. This factor is unexplained. In the 5-, 6- and
7-year-old groups at Grand Rapids, tlie decayed-mottled-filled rates now approxi-
mate those of comparable groups of children in Aurora. Preliminary analyses
of the 1950 dental examinations at Muskegon and Grand Rapids indicate that
the observed dental caries experience at Muskegon is again similar to that re-
corded in the 1944-45 base line. At Grand Rapids a further reduction in dental
caries prevalence was observed.
■^Tpstimony givon durins: thp hparinar on the tolerance for fluoride spray residue on
apples and pears, held pursuant to the notice Issued bv the Federal Security Administration,
May 1, 1944 (9 F. R. 4654).
466 FLUORIDATION OF WATER
In another study, beginning in May 1945, sodium fluoride was added to the
water supply of Newburgh, N. Y., to provide a content of 1.2 parts per million,
whereas the Kingston, N. Y., supply was and has continued to be fluoride-free.
At the end of four years of fluoride treatment of Newburgh's water supply,
analysis was made of the data on dental caries experience both of deciduous
and permanent teeth of approximately 3,200 school children 5 to 12 years old
in Newburgh, and 3,100 children of the same age in Kingston. In brief, the
investigators conclude that the decayed-mottled-filled rates among permanent
teeth of the 6-to-12-year-old children in Newburgh show a consistent downward
trend after 4 years of fluoridation, whereas the decayed-mottied-filled rates in
the control city of Kingston show no changes. The reduction in Newburgh is
from 20.6 decayed-mottled-fllled per 100 permanent teeth to 13.9, or a reduction
of 32.5 percent. The rate in Kingston remained at 20.2 decayed-mottled-filled
per 100 permanent teeth. Because the first permanent molars are the teeth most
affected by dental caries, a special analysis of the condition of these teeth was
made. The number of caries-free first permanent molars increased in New-
burgh, after four years of fluoride exposure among 6-to-9-years-old children, fi-om
59 per 100 molars to 77. The number of caries-free permanent teeth among
Kingston children of the same age remained essentially unchanged.
From these two studies, therefore, it appears that the adjustment of the fluo-
ride concentration to optimal amounts in a water supply previously deficient in
this element has resulted in considerable reduction of caries in children. Just
how great a reduction may be ultimately effected will have to be determined
after a longer period of observation. Reports from other cities which have
installed this procedure tend to corroborate the studies mentioned (19-23).
Continued observations, however, are essential for the establishment of the
degree of effectiveness for higher age groups.
9. In the control studies to which reference was made in the preceding para-
graph, sodium fluoride (NaF) was added to the water supplies. If the avail-
ability of fluoride ion is the same, the use of sodiiim silicofluoride (fluosilicate,
NazSiFe) should result in considerable savings. Experimental studies indicate
that the fluorine in sodium fluoride and sodium iiuosilicate produce similar
physiological effects upon rats (24), and are equally effective in inhibiting the
development of induced dental caries in rats (25). Accordingly, it is inferred
that this principle would apply to human experience as well, although it has not
yet been demonstrated. Other considerations being equal, for reasons of econ-
omy the cheaper material (fluosilicate) is recommended. For smaller public
water supplies, however, other factors such as the amount of available space,
handling hazards, and equipment preference will determine the choice of the
compound used.
10. The statement that fluoridation of water supplies reduces tooth decay by
65 percent is postulated on an expectancy for a population using a fluoride-free
water supply. When a public water supply naturally containing 0.4-0.5 parts
per million, of fluoride is adjusted to the optimal level (1.0 p. p. m.), the reduc-
tion in dental caries prevalence obviously would be less. Upon the basis of infor-
mation at present available, it is not possible to predict how much reduction
of caries Avill be apparent in the adult population. Other factors — genetic,
dietary, bacterlologic, the availability of dental services, and so on — affect the
prevalence of caries and vary in every community. Fluoridation is a partial
caries-control procediire and does not eliminate the need for other dental health
measures.
11. The promotion, initiation, siipervision, and proper operation of the
fluoridation of public water supplies is a responsibility of the State department
of health, acting jointly through its bureau or division of dental health and
through the division of public health engineering, with the collaboration of the
dental and medical professions. Suitable local plans for dental health surveys
before fluoridation and periodic evaluations should be set up by the dental public
health program director. These surveys should provide data suitable for cal-
culating an index of caries attack and an index of the frequency and severity
of dental fluorosis. Engineering aspects of fluoridation, such as tests to deter-
mine the fluoride content of the water, safety provisions, and training of oper-
ators, should be covered by State regulations. The statement of policy and
procedure formulated by the American Water Works Association will be accept-
able to most State departments of health (26). Municipalities contemplating
the installation of fluoridation should look to the State health depavtnipnt for
expert guidance. Many small communities would be unable to maintain satis-
factory fluoridation practice without assistance. There are many so-called auto-
FLUORIDATION OF WATER 467
matic plants applying chlorination, which allegedly do not require full-time
attendance of a waterworks operator. Many have very limited laboratory
facilities or lack technical personnel to make accurate chemical determinations
of fluoride content. Ultimately, State or regional laboratories will have to take
over routine chemical examination of samples along with established bacterio-
logical control. Provision for periodic visits by a State sanitary engineer cannot
be considered adequate supervision.
SUMMARY AND CONCLUSIONS
Under normal conditions of living, fluorine is a trace element in human nutri-
tion. A variable and important source of it is drinking water. Many of the
public water supplies in the United States are deficient in this element. Chil-
dren who depend upon such supplies have a high dental-caries-attack rate com-
pared with children living in cities having water supplies containing approxi-
mately 1 parts per million of fluoride. The advantage of the latter group is con-
siderable and amounts to one-third to one-half as much caries. The caries-
preventive effect of adequate fluoride intake is principally conferred upon chil-
dren until approximately the twelfth year of life — the period during which
dentine and enamel of the permanent dentition are being formed. This increased
resistance to dental caries is carried over into later life to an appreciable
degree.
The results of experimental studies conducted in the laboratory give con-
sistent support to the concept of the inhibitory effect of fluoride on the caries
process. There is a safe margin between trace quantities in drinking water
which are required for optimal dental health and that amount which produces
undesirable physiological effects. The most .sentsitive indication of the latter
amount is interference with normal calcification of the teeth which is manifest
in mottled enamel, or endemic fluorosis. This effect, although compatible with
caries-resistant tooth structure and, within certain limits, with apparent physi-
ological well being, is esthetically undesirable. The level of fluoride concen-
tration in drinking water that is associated with the appearance of mottled
enamel varies with individual susceptibility and with the amount of water con-
sumed. The upper level of safety has been reached, in the northern part of the
United States, in domestic water supplies containing approximately 1.0-1.5 parts
per million fluorine and. in the Southern part of the country, with supplies con-
taining approximately 0.7 parts per million.
There is no reason to believe that prolonged ingestion of drinking water with
a mean concentration below the level causing mottled enamel will have an ad-
verse physiological effect. Progress reports in several communities in which
sodium fluoride has been added to the water supplies of low fluoride content
indicate that this procedure will reduce the caries-attack rate in children. There
is evidence to suggest that it will confer an appreciable measure of protection
to their teeth after they have become adults.
In view of these considerations, this committee recommends that any com-
munity that has a child population of sufiicient size and obtains its water supply
from sources which are free from or are extremely low in fluorides should con-
sider the practicability and economic feasibility of adjusting the concentration
to optimal levels. This ad.1ustment should be in accordance with climatic factors,
and a constant chemical control should be maintained. "With proper safeguards,
this procedure appears to be harmless. However, it should be conducted under
expert dental and engineering supervision by the State board of health. It
should not be undertaken unless this supervision can be provided.
The degree of reduction in the prevalence of caries that will actually be
realized in a particular community will varv according to locnl conditions. The
procedure will supnlement but not supplant other dental health measures.
Approximatelv one-hnlf of the population of this country is livins in small vil-
lases and rural areas and will not benefit by fluoridation of public water sup-
plies.' Other provisions for preventine dental caries in this fraction of the
population should be continued and developed.
-To nrpvpnt mlsintPT-nrptatinTi of thfs stntpmprt. it mav bp nPCos«nrv to point ont that.
upon thp bn^is of fhp T^P^O pppcns, .nhoiit opp-thirrl of tho 'Nration'<5 nomila^^ion r1oo« pot havp
pnhliV wntPT'-snpnlr sprvipp. Tt was ttip opinion of thp nopimittpp. w'ipp 'writinrr ttip rpport.
thnt in sptpp pomTnnp'^^'ps! wtiprp a pphlip T^'atpr ppoolv pT'^te. tVio rhild po^nlition piip-ht
hp so f^mnll npfl thp ahilitv to nrovirlp comppfpnt poptrol of flnoririation so pnlikolv. that for
thp pro'j'^nt nt Ipn^t it ohoiilrl hp assnpipfl that onp-haif of the popnlation is hpyond thp
reach of communal fluoridation of the -water supply. — Ed.
468
FLUORIDATION OF WATER
Illustration 2 presents graph of data in Table IV.
Illustration 2
PERCENTAGE OF CHILDREN (AGE 6-17) HAVING NO DMF TEETH
IN FLUORINE AND NON-FLUORINE AREAS— 1944
lUU/.
90f.
mi
M
«i
ivtl
m
1 \
\ \
c;rw
I \
\
\
\
\
DU/d
10/,
30/.
20/.
1
\
\
\
\
\
\
\
\
37t
\
\
\
\
>
\
?,<,?.
\
/
\
*».
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\
\
\
111,
\
\
\
UT.
'i?'--
10/.
\
\
J
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3
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i
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AGE5
FLUORINE AREAS
NON-FLUORINE AREAS
FLUORIDATION OF WATER 469
References
(1) McClube, F. J. Fluorine and Other Trace Elements in Nutrition. In Hand-
book of Nutrition. Am. Med. Assn., Chicago, 111. (2nd ed. 1951), p. 137.
(2) Hill, I. N. ; Jelinek, O. E. ; & Blayney, J. R. The Evanston Dental Caries
Study. III. A Preliminary Study of the Distribution of Fluorine in Communal
Water Supplies in the United States. Jour. Dental Research 28:398 (1949).
(3) Dean, H. Trendley. Epidemiological Studies in the United States. In
Dental Caries and Fuorine. Am. Assn. Advancement Science, Washington,
D. C. (1946), p. 5.
(4) . Dentistry in Public Health. Am. Pub. Health Assn., Albany,
N. Y. (1949).
(5) Forrest, J. R. The Incidence of Dental Caries Among Adults and Young
Children in Three High- and Three Low-Fluorine Areas in England. Bui.
Ministry of Health & Public Health Lab. Service, 10 :104 (May 1951).
(6) Russell. A. L. & Elvove. E. Domestic Water and Dental Caries. VII.
A Study of the Fluoride-Dental Caries Relationship in an Adult Population.
Pub. Health Rpts., 66:1389 (1951).
(7) Dean, H. Trendley. The Investigation of Physiological EiTects by the Epi-
demiological Method. In Fluorine and Dental Health. Pub. No. 19, Am. Assn.
Advancement Science, Washington, D. C. (1942), p. 23.
(8) . The Advancement of Fluoridation. Jour. AWWA, 43:17 (Jan.
1951).
(9) McClure, F. J. Nondental Physiological Effects of Trace Quantities of
Fluorine. In Dental Caries and Fluorine. Am. Assn. Advancement Science,
Washington, D. C. (1946), p. 74.
(10) Cox. O. .]. & Hodge, H. C. The Toxicity of Fluorides in Relation to Their
Use in Dentistry. Jour. Am. Dental Assn., 40 :440 (1950).
(11) Heyroth, F. F. Fluoridation of the Water Supply in the Prophylaxis of
Dental Caries. Cincinnati, Ohio, Board of Health {Unpublished report).
(12) Smith, F. A. An Annotated Bibliography of the Literature on the Phar-
macology and Toxicology of Fluorine and Its Compounds. Univ. of Rochester,
Rochester, N. Y. (Jan. 1951).
(13) RoHOLM, K. Fluorine Intoxication. H. K. Lewis & Co., Ltd., London
(1937).
(14) Hodges, P. C. ; Fareed, O. J. ; Ruggy, G. ; & Chudnoff, J. S. Skeletal
Sclerosis in Chronic Sodium Fluoride Poisoning. Jour. Am. Med. Assn.,
117:1938 (1941).
(15) Machle, W. & Largent, E. J. The Absorption and Excretion of Fluorides.
II. The :\Ietab()lism at High Levels of Intake. Jour. Ind. Hygiene & Toxi-
colouy, 2.".: 112 (1943).
(16) Dean, H. Trendley; Arnold, F. A., Jr.; Jay, P.; & Knutson, J. W.
Studies on Mass Control of Dental Caries Through Fluoridation of the Public
Water Sunply. Pub. Health Rpts.. 65 : 1403 ( Oct. 27. 1950) .
(17) AsT, David B. ; Finn, S. B. ; & McCaffray, I. The Newburgh-Kingston
Caries Fluorine Study. I. Dental Findings After Three Years of Water
Fluoridation. Am. Jour. Pub. Health, 40:716 (1950).
(18) ; ; & Chase, H. C. The Newburgh-Kingston Caries Fluo-
rine Study. III. Further Analysis of Dental Findings Including the Perma-
nent and Deciduous Dentitions After Four Years of Water Fluoridation. Jour
Am. Dental Assn., 42:188 (1951).
(19) HuTTON, W. L. ; Linscott, B. W. : & Williams. B The Brantford Fluo-
rine Experiment: Interim Report After Five Years of Water Fluoridation.
Canadian Jour. Pub. Health, 42 : SI (Mar. 10.51).
(20) Bull, F. A. Control of Dental Caries by Addition of Fluorides to Public
Water Supplies. Jour. Am. Dental Assn., 41:146 (Aug. 1950).
(21) Erlenbach, F. M. & Tracy, E. T. Control of Dental Caries by Artificial
Fluorination of a Water Supply. Conn. Health Bui., 60:203 (Sept. 1946).
(22) & . Control of Dental Caries by Artificial Fluorination of
a Water Supply — Second year. Conn. Health Bui., 62:9 (Jan. 1948).
(23) Hill. I. N. : Blayney, J. R. : & Wolf, W. The Evanston Dental Caries
Study. VI. A Comparison of the Prefluoride and the Postfluoride Caries Ex-
perience of 6-, 7-, and 8- Year-Old Children in the Study Area (Evanston, 111.).
Jour. Dental Research, 29 :534 (1950) .
(24) McClure, F. J. The Availability of Fluorine in Sodium Fluoride vs.
Sodium Fluosilicate. Pub. Health Rpts., 65:1175 (Sept. 15, 1950).
k
470 FLUORIDATION OF WATER
(25) ZiPKiN, I. & McClure, F. J. Complex Fluorides: Caries Reduction and
Fluorine Retention in the Bones and Teeth of White Rats. Pub. Health Rpts.,
66:1523 ( Nov. 23, 1951 ) .
(26) The Fluoridation of Public Water Supplies. Am. Water Works Assn., New
York (1949) ; see also Jour. AWWA, 41:575 (July 1949).
Committee Personnel
Kenneth F. Maxcy, Chairman; professor of epidemiology, School of Hygiene
and Public Health, Johns Hopkins University.
J. L. T. Appleton, professor of microbiology, University of Pennsylvania.
Basil G. Bibby, director, Eastman dental dispensary.
H. Trendley Dean, director, National Institute of Dental Research, National
Institutes of Health.
A. McGehee Harvey, professor of Medicine, Johns Hopkins Hospital.
Francis F. Heyroth, associate professor. Industrial Toxicology, assistant direc-
tor, Ketterling Laboratory, College of Medicine, University of Cincinnati.
A. LeRoy Johnson, former head, Harvard School of Dental Medicine, dental
consultant, National Research Council.
Harold A. Whitaker, professor of public health engineering. School of Public
Health, University of Minnesota.
Abel Wolman, professor of sanitary engineering, Johns Hopkins University.
Discussion of Data
It would appear from a careful analysis of the data presented here that the
superior dental conditions found in the children residing in the fluorine areas
before and after the second birthday were not due to chance.^ Other variables
call for further investigation, for example, the geographical location of children.
Most of the data in the nonfluorine areas presented in this article were obtained
in the northern part of the State, while the children in fluorine areas were in
south Jersey. The bureau of dental health will obtain more data of dental con-
ditions among the children in nonfluorine areas in south Jersey. The find-
ings will he publislied later. Also the bureau hopes to conduct continuous dental
programs in the fluorine areas to investigate dental conditions among the total
population having had the benefit of fluorine over long periods of time.
The University of Rochester,
School of Medicine and Dentistry,
Rochester, N. Y., May 25, 1954.
Hon. Charles A. Wolverton,
Chairman, Committee on Interstate and Foreign Commerce,
House of Representatives, Washington, D. C.
Dear Sir : This letter is written to voice my opposition to the so-called Wier
bill, H. R. 2341, "A bill to protect the public health from the dangers of fluori-
nation of water."
My background in fluorine studies dates from 1939 with the publication of
observations on certain biological effects of fluorides in experimental animals.
Since that time I have studied and published reports concerned with biological
effects of fluorides especially those having to do with dental caries, with the
toxic effects of fluorides, and with the safety of water fluoridation.
My education in science has led to the granting of a bachelor of science degree
in 1925 from Illinois Wesleyan University, master of science degree and Ph. D.
from the State LTuiversity of Iowa in 1927 and 1930, respectively. In 1949 a
doctor of science honoris causa was given to me by my alma mater, Illinois
Wesleyan University.
During the years 1931 and 1937 I served as a Rockefeller senior fellow and
then as assistant professor of dentistry (biochemistry) in the School of Medicine
and dentistry. University of Rochester. During this time I studied the physical
and chemical properties of teeth and bones. From 1937 to 1946 I was assistant
professor and associate professor of biochemistry and pharmacology. In 1946
I become professor of pharmacology and toxicology. Since 1937 I have been
continuously engaged part time as a consultant toxicologist for a number of indus-
trial companies. Beginning in the spring of 1943 when the Manhattan Project
established a research project at the LTniversity of Rochester, I have held the
' Statement supported by chl square determinations.
FLUORIDATION OF WATER
471
title of chief pharmacologist. In the course of this work I was among those
present at the Bikini tests in July 1946. Our work for the Manhattan Project,
and since January 1, 1947, for tlie Atomic Energy Commission, has involved
studies of the toxicity of fluorine, of uranium, of beryllium, and of other elements
and comi)ounds of especial interest to the AEC. My duties have included super-
vision of inhalation toxicity tests, oral toxicity tests, skin and eye toxicity tests,
and studies of the mechanism and therapy of poisoning. At present I am chair-
man of the technical advisory committee on the fluoridation of water supplies of
the State of New York Department of Health. I am also chairman of the Com-
mittee on Toxicology of the Division of Chemistry and Chemical Technology of
the National Research Council.
I am a member of the American Society of Pharmacology and Experimental
Therapeutics, the American Society of Biological Chemists, the American Chem-
ical Society, the Society for Experimental Biology in Medicine, the American
Industrial Hygiene Association, the International Association of Dental Research,
the American Association for the Advancement of Science, and the Kansas, New
York, and Rochester Academies of Science. I am the author of more than 100
papers on various subjects mostly in the fields of biochemistry, pharmacology
and toxicology and the coeditor with Dr. Carl Voegtlin of a monograph in 4
volumes on the Pharmacology and Toxicology of the Uranium Compounds.
I wish to oppose the proposition put forward by the bill known as the Wier
bill, H. R. 2341, a bill to protect the public health from the dangers of fluorina-
tion of water. This bill attempts to set up conditions that would prohibit the
use of fluorides in the community drinking water supply. I wish to include as
a part of my statement a report of the Food and Nutrition Board entitled "The
Problem of Providing Optimum Fluoride Intake for Prevention of Dental Caries,"
Publication 294 of the Division of Biology and Agriculture, National Research
Council. In the summary and conclusions of this report on page 13, item 5 is as
follows : "The adjustment of the fluoride content of drinking water to 1 part per
million fluoride is in principle and in practice the soundest and most effective
approach to caries prevention on a large scale known today." The benefits of
fluoridating water supplies have been proven. These benefits are so great that
the only grounds that would justify the prohibition of the use of fluoride in
drinking water is the demonstration of an injury or the hazard of an injury
to the health of the users of such water.
Whenever a proposal is made to fluoridate the water supply of a community
a critical question — is it safe? — is always raised. My opinion can be given: AU
of the available evidence indicates that there is no danger in water fluoridaton.
To answer this question completely would require a much longer discussion than
can be given here. The main points of reference, however, can be cited. Dr.
Frank A. Smith of this Department and I have recently summarized the impor-
tant clinical effects of fluorides in 4 categories ; 3 of these are toxic effects and
the fourth is the use of fluorides in preventive dentistry.
Category
Dose fre-
quency
Amount
Time
Clinical effect
Acute poisoning
Single
Daily
--.do_
--.do
5to lOgrams
20 to 80 milligrams or
more.
2 to 8 milligrams or
more.
1 to 1.5 parts per mil-
lion in water.
2 to 4 hours
Death.
Chronic high grade
10 to 20 years . -
Crippling fluorosis.
Mottled enamel.
Decreased dental
Riries.
poisoning.
Chronic low grade poi-
soning.
Preventive dentistr>'_..
Daily during 1st 8
years of life.
1st 8 years and later-..
Acute toxicity factor of safety in water fluoridation. — For a number of rea-
sons it is difficult to make a reliable estimation of the minimum amount of flu-
oride that will certainly cause death in a human adult. Nevertheless it may be
stated with a high degree of probability that a retained dose of 5 to 10 grams
of sodium fluoride will be lethal. When this figure is compared with the 1
milligram ingested daily by an adult who drinks a quart of fluoridated water
(1 part per million), an acute lethal effect is clearly seen to l)e impossible. A
factor of safety of 2,500 to 5,000 fold is established. In a child the safety fac-
tor may be estimated at 250 to 500 fold.
Occasionally the question is raised whether an accidental addition in a water-
treatment plant (for example dumping a day's supply of fluoride into the water
in an instant) might produce dangerously high concentrations. A little arith-
472 FLUORIDATION OF WATER
luetic will provide a reassuring answer. If a day's supply were delivered over
a period of an hour the water would contaiin only 24 parts per million ; this
amount might be taken daily for 10 years without serious difficulty. Further-
more for a city like Rochester, N. Y., to add to the water supply a sufficient
amount to be acutely toxic, that is deadly, a total of 400 tons of fluoride would
have to be added to the volume of water distributed daily to the city. The ma-
chine in Rochester that adds fluoride to the water has a hopper that contains
1,000 pounds ; an acute poisoning is mechanically impossible.
Clironic high-grade poisoning, crippling fluorosis, factor of safety in icater
fluoridation. — ^Among the prominent toxic effects observed after long continued
exposures, that is 10 to 20 years, to large amounts of fluoride (20 to 80 milli-
grams per day or more) are abnormalities of the skeleton. This comparative-
ly rare disorder has been observed in a few men who worked in a dusty flu-
oride industry ; the reported cases mostly have come from foreign countries.
Skeletal changes of lesser severity have been observed in 13 of 114 residents of
Bartlett, Tex., where the drinking water contained 8 parts per million. These
13 persons were described as showing some osteosclerosis. This term is applied
to an increased resistance to the passage of X-rays. None of these 13 persons
reported any disability or illness from the increased density of their bones. A
survey of approximately 140 residents of communities in which the drinking
water contained 2 or 3 parts per million of fluoride revealed that not 1 person
had any detectable skeletal changes. Between the amount of fluoride that
will produce osteosclerosis in humans and the amount obtained by drinking
fluoridated water (1 part per million of fluoride), there is a safety factor of
8 to 20 fold.
Doses producing enamel hypoplasia or mottled enamel, factor of safefii i)i
water fluoridation. — Detectable enamel hypoplasia or mottled enamel in the
human is endemic in areas where the driukins water contains 2 to ." parts per
million or more. In these populations there is no other known toxic effect of
fluorides ; mottled enamel is therefore the most delicate index of fluorosis.
It should be emphasized that the condition of mottled enamel can be pro-
duced only during the years that the enamel organ is functioning; that is, only
when the tooth is being formed in the jaw and preceding eruption, can the
changes occur which later appear as mottled enamel. There is an extraordi-
narily precise relation between the severity of dental fluorosis and the amount
of fluoride in the drinking water. The evidence on which this statement is
based comes from the extraordinarily fine epidemiological surveys of Trendley
Dean and his colleagues. On the basis of the available evidence from human
studies a two-fold factor of safety exists between levels of fluorides producing
detectable mottled enamel even in a few individuals and a level of 1 part per
million. Although the margin of safety for mild mottling is only twofold,
this safety factor is established firmly.
Considerations of the metabolism of fluorides in the body increase our con-
viction of the safety of water fluoridation. The body possesses two pote>nt
detoxification mechanisms: (1) Rapid excretion in the urine; (2) rapid stor-
age in the skeleton. Deposition in bone mineral although it increases the con-
tent of fluoride in the bdy is harmless in itself and is not permanent; mobiliza-
tion and excretion continuously remove fluoride. Even if all the fluoride ingested
in the drinking water (1 part i)er million) in a lifetime were stored in the skele-
ton, no injury would thereby accrue.
The ultimate proof of the safety of water fluoridation is the good health of
populations drinking fluoride-containing water. At present the most extensive
information comes from the Newburgh-Kingston study based on the exceptional-
ly detailed pediatric study in which more than .WO children in each city have
been examined annually in a pi'ogram that has now (spring of 19.54) been in
existence nearly 9 years, it has been concluded that no deleterious systemic effects
have occurred. The relatively few observations from fluoride and nonfluoride
areas by which it is possible to compare height, body weight, bone fracture
experience and death rates from heart disease, cancer, and nephritis consistent-
ly show no ill effects (save mottling of the enamel from excessive amounts of
fluorides).
Conclusion. — Considering all the available evidence it is my opinion that the
health hazards do not justify postponing water fluoridation.
I request that this statement be made a part of the record of the hearing.
Tours truly,
Harold C. Hoikj'e,
Professor, Pharmacology and Toxicology.
FLUORIDATION OF WATP:R 473
[Publication 294. Division of Biology and Agriculture, National Research Council,
November 1953]
The Pkoblem of Pkovidino Optimum Fluoride Intake for Prevention op
Dental Caries
A report of the Committee on Dental Health of the Food and Nutrition Board,
prepared by the Subcommittee on Optimum Fluoride Levels — R. F. Sognnaes,
Chairman, F. A. Arnold, Jr., H. C. Hodge, O. L. Kline
the food and nutrition board
The Food and Nutrition Board is an activity of the National Research Council,
established under the council's Division of Biology and Agriculture. Financial
support for the meetings and publications of the board has been provided pri-
marily from private sources such as the Milbank Memorial Fund, the Nutrition
Foundation, and the Williams-Waterman Fund of the Research Corporation.
Members of the board and its committees serve without compensation beyond
their actual expenses.
The National Research Council is a part of the organization of the National
Academy of Sciences. Grants for the work of the Food and Nutrition Board
are received and administered by the academy, which is a private, nonprofit cor-
poration chartered by act of Congress in 1863 for the furtherance of science and
to provide a source of scientific advice to the Federal Government.
foreword
The Food and Nutrition Board in the spring of 1953 appointed a subcommittee
under the committee on dental health "to study the problem of providing an opti-
mum amount of fluoride in the American diet including the water supply." The
subcommittee members were F. A. Arnold, Jr., D.D.S., Director, National Insti-
tute for Dental Research, National Institutes of Health, Bethesda, Md. ; H. C.
Hodge, Ph.D., professor of pharmacology. University of Rochester, School of
Medicine and Dentistry, Rochester, N. Y. ; O. L. Kline, Ph.D., Director of Re-
search, Division of Nutrition, Food and Drug Administration, Washington, D. C. ;
and R. F. Sognnaes, D.M.D., Ph.D., professor of oral pathology. Harvard School
of Dental Medicine, Boston, Mass. (chairman). G. B. Forbes, M.D., associate
professor of Pediatrics, University of Rochester, School of Medicine and Den-
tistry, Rochester, N. Y., and F. J. Stare, M.D., Ph.D., professor of nutrition. Har-
vard School of Public Health, Boston, Mass., have cooperated in preparing this
report, without formal appointment to the committee.
The text of this report will include discussion of (I) the magnitude of the
caries problem compared with conventional approaches to prevention, (II) the
efficacy and safety of fluoridation, (III) the vehicles for fluoridation, and (IV)
summary and conclusions.
By way of definition the committee presents the following general statement
in regard to its understanding of the term "optimum amount of fluoride" :
Fluorides are universally present in the earth's soil, its plants, and animals,
including man. No one has so far been able to produce a fluoride-free diet,
human or animal. Hence, while a certain amount of fluoride is obviously com-
patible with normal health, the minimum fluoride level conducive to optimal gen-
eral health has not been determined.
The optimum level of fluoride intake must at this time be defined as that which
in epidemiological and clinical observations has been found to combine the
highest degree of caries protection with the lowest degree of mottled enamel.
This level refers to the added amount of fluoride derived from drinking water
containing or adjusted to contain 1 part per million of fluoride, assuming a basic
dietary fluoride intake from average American foods which is relatively low but
not necessarily constant or unchangeable. This fluoride level, while optimal for
caries prevention, is higher than would appear necessary to satisfy standard ref-
erences of adequate nutrition, such as reproduction, growth, and general health.
Thus, while there does appear to be an optimum level of fluoride intake as a
practical means of caries prevention, information is lacking at present to take
into consideration the possibility of other beneficial effects.
474 FLUORIDATION OF WATER
I. THE MAGNITUDE OF THE CAKIES PROBLEM VERSUS CONVENTIONAL APPROACHES TO
ITS PREVENTION
During recent centuries, the civilized world has seen an alarming increase in
the prevalence of dental decay (Krikos, 1935). A longitudinal survey made in
this country gives no indication that this upward trend in the incidence of decay
has leveled ofC during the last few decades (Brekhus, 1951) .
In terms of dollars and cents, the United States Department of Commerce
has recently reported that the total annual personal expenditure for dental care
in the United t^tates is above $1 billion. Although enrollment in the Nation's
42 dental schools has increased almost 50 percent during the last decade, it is
generally estimated that only 25 percent of the actual dental needs are met
through conventional dental care by the Nation's 80,000 dentists and, hence, that
their number would have to be quadrupled if existing dental defects were to
be remedied. According to a recent survey (Moen, 1953), the suffering from
untreated decay, while practically universal, is particularly widespread in the
lower income bracket. Under these circumstances it would clearly be a major
contribution to the conservation of human resources if a method of caries pre-
vention could be developed which would reach the major part of the population.
Because the most widely accepted concept of caries attributes the disintegra-
tion of the teeth to agents contributed by the oral environment, the major effort
toward caries prevention has, during the present century, been directed toward
the elimination of the oral microorganisms, their substrate, and their products.
While there is much evidence that these factors play an important role in the
etiology of dental caries, the present prevalence of the disease, referred to
above, indicates that our efforts to apply this theory in pracitce have not suc-
ceeded in reversing the upward trend of caries. The paradoxical situation
now exists where the United States population spends, in addition to the tre-
mendous cost of dental restorations, very large sums on so-called therapeutic
dentifrices. Besides being effective, the ideal caries-preventive method should
to the greatest possible extent conserve the time, the cost, and the efforts of
the individual, and at the same time present no health hazard in its application.
II. THE EFFICACY AND SAFETY OF FLUORIDATION
Reports now available indicate that for the general population the fluorida-
tion of public drinking water is more effective than any other known procedure
in preventing dental decay (see table 1). Over 15 million people in about 900
United States communities are now served by public water supplies supple-
mented with 1 part per million fluoride. At the same time there are as many
communities, covering more than SV2 million people, using water supplies which
by nature are provided with a fluoride content of 1 part per million fluoride
and^ over. On the strength of these and other data, it may now be considered
as proved that increasing the fluoride content of community water supplies to
an optimal level has a caries-preventive effect comparable to that observed in
communities with naturally fluoridated water. Furthermore, it is becoming
evident that the maximal caries-preventive effect of fluoride is provided to those
children receiving optimal amounts of fluoride during the lime the teeth are
in the formative stage ; that is, the period between infancy and adolescence,
iidditional evidence is accumulating which suggests that beneficial effects are
also obtained in teeth already erupted in older children and that the benefits
extend into adult life. While all teeth contain some fluoride, the amount depends
upon the fluoride intake (McClure and Likins, 1951), primarily during the
period of tooth development. The fluoride is probably deposited in the mineral
of the dental hard tissues in exchange for hydroxyl ions in the apatite lattice,
giving a fluorapatite crystal or a mixed fluor-hydroxyl apatite crystal.
A number of biological effects of fluorides have been described (McClure,
1946). Some of the specific actions have been studied in sufficient detail to
serve as a basis for a quantitative estimation of the metabolism and storage of
fluorides.
Acute lethal poisoning from inorganic fluoi-ides has been reported in 00 cases
reviewed by Roholm in 1037. since which time Smith. Hodsie, and Cox (1953)
have compiled a report on a total of 77 deaths attributed to fluorides. It is
probable that for the adiilt a retained dose of 5 to 10 grams of sodium fluoride
will be lethal. When this figure is compared with the 1 milligi-am ingested daily
by an adult who drinks a quart of fluoridated water d part per million of fluo-
ride), a factor of safety of twenty-five hundred- to five thousand-fold is estab-
FLUORIDATION OF WATER
475
lished. In a child, the safety factor may be estimated at two hundred and fifty-
to five hundred-fold. With water as a vehicle and the concentration at 1 part
per million fluoride, fatal poisoning from drinking such water is impossible.
Growth retardation in children as the result of fluoride exposure has not been
reported. In several species of animals — mouse, rat, rabbit, guinea pig, chicken,
dog, swine, sheep, goat, cattle, and monkej- — rations containing less than 100
parts per million, consumed for periods of a year or less, were reported to have
no deleterious effect on growth. Rabbits were found to grow normally on a ration
at the 200 parts per million fluoride level, swine at the 300 parts per million level.
In contrast, dogs, calves, chicks, sheep, and monkeys exhibited growth retardation
when given rations containing 100 to 125 parts per million fluoride or more.
If these results are applicable to the caries-preventive level of fluoride in man,
the factor of safety against growth retardation is fifty- to one hundred-fold.
Skeletal changes are among the prominent chronic effects observed after long-
continued exposures to large amounts of fluoride (20 to 80 milligrams per day
or more). These abnormalities of the skeleton manifest themselves as osteo-
sclerosis, osteoporosis, and exostoses of the long bones and of the vertebra, pelvis,
jaw bone, and other flat bones ; with somewhat smaller amounts, yet many times
the 1 part per million of water fluoridation, minor alterations in bone architec-
ture, e. g., thickening of trabeculae, have been reported.
Table 1. — Fluoridation study projects
Community
Fluoridation
Date started
Report
period
(years)
Age group
(years)
Reduction
in decay '
(percent)
Grand Rapids, Mich 2
Brantford, Ontario, Canada 3
Newburgh, N. Y *
Evanston, 111 i
Sheboygan, Wis '.
January 1945.
June 1945.
May 1945.
February 1947.
February 1940.
79-10
8 12-14
70.8
52.5
49.2
48.1
39.7
59.4
69.5
51.5
46.2
32.9
69.4
67.8
40.4
51.4
73.6
56.4
35.4
35.3
29.7
> DMF permanent teeth.
2 Arnold, F. A., H. T. Dean, and J. W. Knutson. Unpublished data from 8th Year of Grand Rapids-
Muskegon Study. Obtained from Grand Rapids 1952 data.
3 Button, W. L. Personal communication to committee member, Feb. 2, 1953.
< Ast, D. Personal communication to committee member, including mimeographed data from 1952
examinations.
5 Hill, I. N., J. R. Blaney, and W. Wolf. The Evanston Dental Caries Study. J. Dental Research 31:
346-353, 1952.
« Bull, F. A. Personal communication to committee member and material obtained from Wisconsin
State Board of Health, November 1952.
' 4th grade.
' 8th grade.
In a recent report on the medical aspects of fluorosis in Bartlett, Tex., where
the drinking water contained 8 parts per million fluoride (Shimkin, Arnold,
Hawkins, and Dean, 1953), there was a great similarity between the high-fluoride
group and the control group with respect to the number and types of disease
symptoms elicited in the medical histories. Thei-e was, as would be expected,
a high incidence of mottled enamel and an increased bone density in the spine
and pelvis. However, the greater incidence in the high-fluoride group of a cer-
tain brittleness and blotching of the fingernails, of hypertrophic changes in the
spine and pelvis, and of lenticular opacities of the eye requires further epidem
iologic investigation, in view of the fact that the fluoride level in this community
was eight times above that recommended for fluoridation.
48391—54-
-31
476 FLUORIDATION OF WATER
From animal studies it appears that ttie factor of safety between amounts pro-
ducing skeletal changes and amounts that would be taken in when the drinking
water contains 1 part per million is about fiftyfold. Between the amount of
fluoride that will produce osteosclerosis in humans and the amount obtained at
the caries-preventive level (drinking fluoridated water containing 1 part per
million fluoride), there would appear to be a safety factor of eight- to twenty-
fold.
Mottled enamel is the most delicate index of chronic fluorosis. In man,
mottled enamel is endemic in areas in which the drinking water contains 2 to 5
parts per luillion fluoride or more. In these populations there is no other known
toxic effect of fluoride.
It should be emphasized that this effect of fluoride can only be produced dur-
ing the years that the teeth are developing. Once teeth have erupted into the
mouth, enamel mottling cannot occur. There is a precise relation between the
severity of mottling and the logarithm of the parts per million fluoride in the
drinking water. The intersection of the line which relates the index of mottling
to the fluoride intake and the line which relates caries to fluoride intake occurs
at 1 part per million ; this concentration therefore has the significance of max-
imal tooth health with minimal hazard. On the basis of the available evidence
from buman studies, this caries-preventive level allows for a twofold factor of
safety against mottled enamel.
The statistical distribution of mottling shows that the incidence of mottling
is a dosage-response phenomenon analogous to the dosage-response relationship
observed in classical pharmacology. The more fluoride present in the water
supply, the more severe the mottling, with the usual biological range in the indi-
vidualized response.
Excretion and storage. — The outstanding characteristics of the urinary excre-
tion of fluoride are rapidity and selectivity. It has been found, for example,
that normal human adults from a nonfluoridated community, given a dose of
1.5 milligrams of fluoride as NaF dissolved in a glass of water, will excrete
approximately one-third of it in 3 houi'S (Smith, Hodge, and Cox, 1953), and
this represents the greater portion of all that will be excreted. One-third to
one-half of the fluoride absorbed into the body fluids is rapidly deposited in the
skeleton (McClure, 194G; Savchuck and Armstrong, 1951) which depletes fluoride
ion from the circulation as effectively as does urinary excretion and thus may be
classed as a detoxification mechanism.
Although the available evidence is not in complete agreement, it appears that
fluoride storage in the skeleton increases during continuing fluoride exposure,
viz, at a constant level. The fluoride is deposited in the bone mineral, hydroxyl-
apatite, and, since fluorapatite is isomorphous (Bale, 1940), there is no evidence
that the fluorapatite crystal is nonphysiological or fails to function as does
hydroxylapatite. There are instances reported in which animals given fluoride
for long periods of time and in large amounts produced bone with percentages
of fluoride as gi'eat as 2.4 (Maynard, Voegtlin, and Hodge, 19-53) ; i. e., 24,000
parts per million. If it is assumed that one-third to one-half of the fluoride is
deposited, it can be calculated that at the age of 70 years an individual drinking
fluoridated water (1 part per million) would have in his skeleton 3,000 to 4,000
parts per million fluoride, compared to the 1,500 parts per million found in 70-
year-old residents of Rochester with a minimal fluoride intake.
Fluoride, once deposited in the skeleton, is by no means permanently fixed
but may be mobilized into the body fluids as a fluoride ion. Largent (19.53) fol-
lowed the excretion from his own skeleton following the deposition of a total of
1.7 grams of fluoride. There were two phases to the loss of fluoride : (1) a rapid
one of perhaps a month's duration, and (2) a slow process following a linear
course for at least 2 years (Smith, Hodge, and Cox, 19.53). The mobilization of
fluoride from the skeleton and its excretion from the body constitute a safety
mechani.sm tending to maintain the total amount of fluoride in the body at a
low level. Present knowledge, therefore, fails to indicate any health hazard
associated with the extra deposition of fluoride in the skeleton that will un-
doubtedly accompany water fluoridation.
The results of the careful and controlled physical examinations of the New-
burgh-Kingston children give to date a clean bill of health to water fluoridation
under the conditions of this test ( Schlesinger, Overton, and Chase, 1953). Com-
paring Newburgh children with those in Kingston, the control city, the blood
picture is normal, urine analyses are negative, the condition of nails, skin, and
hair is entirely comparable, the results of the eye and ear examinations are
similar, and no detectable difference was found in bone density in cliildren in
FLUORIDATION OF WATER 477
the two cities studied. The results so far have thus revealed no deleterious
svstemic effects from the ingestion of fluoride in drinking water at the level
employed. Furthermore, in areas of the country where drinking waters are
naturally fluoridated, large population groups have been exposed for generations
with no readily evident ill effects save mottling of the enamel when more than
2 parts per million of fluoride is present.
After evaluating the effect on the general health of populations in 22 cities
with and without small amounts of fluoride in the drinking water, the Depart-
ment of Public Health of the State of Illinois concluded: "Mortality statistics
show that there is no signiflcant difference in the general death rates between
areas where fluoride is present and those where it is absent. Similarly, there
is no significant difference in the risk of death from specific diseases such as
heart, cancer, nephritis and diabetes."
From the above considerations it would appear (1) tliat the possibility of
acute fatal poisoning resulting from fluoridation is nil, (2) that cliildren drink-
inf fluoridated water will grow normally, (3) that no detectable alterations will
occur in bone structure at the recommended level of 1 part per million, and (4)
that there is at least a twofold factor of safety in the matter of mottled enamel,
a response which in large groups of children and in numerous communities has
been so mathematically related to dosage that the prediction can be made with
confidence that unesthetic mottling will not be seen with 1 part per million.
III. VEHICLES FOR ELXJOKIDATIOX
The type of vehicle suitable for the administration of fluoride nuist provide
a safe and effective means of reaching the population most concerned ; namely,
children from infancy to adolescence. Using the data of McClure (1943) as a
guide (see table 2) the object should be to supplement the usual fluoride inges-
gestion with approximately 0.5 milligram fluoride per day in the 1- to 3-years-
olds, 0.7 in the 4- to 6-year-olds. 0.9 milligrams per day in the 7- to 9-year-olds,
and 1.1 milligrams per day in the 10 to 12-year-olds (see tables 2 and 3). An
ideal vehicle should be such that its consumption would tend to be self-limiting ;
in other words, the capacity of a child of a given age to consume the vehicle
should not exceed the limit of a safe fluoride intake. At the same time, the
nutritive value, the usage, and the cost of the vehicle should be advantageous
to the largest part of the population. Finally, the vehicle should be such that
there would be uniformity of response and ease of regulatory control, especially
since other sources of fluoride may already be available. The fluoridation of
communal water supplies meets these qualifications. But if supplementary fluo-
ride through other vehicles is to be attempted it is imperative that the fliaoride
content of the individual water supply, as well as that available in common foods,
be determined.
Fluoride content of food. —The most extensive literature surveys now avail-
able on fluoride occurring naturally in food are those prepared by McClure, pub-
lished in 1939 and in 1949. In the latter report, he refers to 41 publications used
as source material. More than 130 foods are listed. The majoritv of foods such
as vegetables, meats, cereals, and fruits found in the average diet contain from
0.2 to 0.3 part per million of fluoride in the foods as consumed. Notable excep-
tions to this range are seafoods and tea. Seafoods are shown to contain 5 to 1.5
parts per million fluoride as consumed, and tea from 75 to 100 parts per million
fluoride on the dry basis. (A cup of tea will supply approximately 0.12 milligram
fluoride.) Exclusive of drinking water, the average diet in the United States is
calculated to provide 0.2 to 0.3 milligram of fluoride daily.
In a survey by Ham and Smith (1950) of dietary fiuoride consumed in Toronto
the food-borne fiuoride was found to range from 0.18 to 0.30 milligram each day'.
These values for a limited Canadian area are in good agreement with the
averages stated by McClure.
No important difference was found between the fluoride content of diets con-
sumed in Cincinnati and in Arizona, two widely separated areas. Clifford (1945)
observed that wheat grown in Deaf Smith County, Tex., a high-fluoride water
area, did not have a fluoride content significantly higher than wheats grown in
other areas. Armstrong and Knowlton (1942) measured the fluoride content of
diets used in the Minnesota General Hospital and found that the average fluoride
intake from such diets ranged from 0.27 to 0.32 milligram per day McClure
(1943) surveyed the fluoride intake of children 1 to 12 years old and calculated
that their food contained from 0.1 to 1 part per million of fluoride on a dry-
48391—54 32
478
FLUORIDATION OF WATER
weight basis and that children in the age range studied had a fluoride intake that
varied from 0.03 to 0.56 milligram of fluoride daily. He pointed out that foods
highest in fluoride, seafoods and tea, do not usually occur in appreciable quanti-
ties in children's diets.
Table 2.-
-MctJiod of estimation of daily intake of fluoride from food containing
0.1 to 1 part per million of fluoride in the dry substance ^
Age (years) -.-
1 to3
4 to 6
7 to 9
10 to 12
Energy allowance (calories)
1,200
1,200
265
0.027
0.053
0.133
0.265
1,600
1,600
355
0.036
0.071
0.178
0.360
2,000
2,000
445
0.045
0.089
0.223
0.450
2,500
2,500
555
0.056
Water requirement (cubic centimeters)
Total dry substance in daily food allowance when 1
gram of dry substance of tlie food furnished 4.5 calories
of energy: Total daily intake of dry substance (grams) .
Fluoride Ingested daily in food in wliich the dry sub-
stance of the food contained the following concentra-
tions of fluoride;
(a) 0.10 parts per milligram (milligrams)
(6) 0.20 parts per milligram (milligrams)
(c) 0.50 parts per milligram (milligrams)
(d) 1 part per milligram (milligrams)
0.111
0.278
0.560
1 Abridged from McClure, F. J.: Am. J. Diseases Children 66: 365, table 3, 1943.
Table 3. — Summary of estimated daily intake of fluoride from food and from
drinking water {drinking tvater containing 1 part per million of fluoride and
dry substance of food containing 0.1 to 1 part per million of fluoride)^
Body weight ^
kilograms
Daily fluoride intake
Age ( years)
From drink-
ing water,
milligrams
From food,
milligrams
Total from
food and
drinking
water,
milligrams
Total as milli-
grams per
kilograms of
body weight
1 to 3 ....
8 to 16
0. 390-0. 560
0. 520-0. 745
0.650-0.930
0. 810-1. 165
0.027-0.265
0.036-0.360
0.045-0.450
0. 056-0. 560
0. 417-0. 825
0. 556-1. 105
0.695-1.380
0.866-1.725
0. 026-0. 103
4 to6
13 to 24
0. 023-0. 085
7to9
16 to 35
0.020-0.068
10 to 12
25 to 54
0. 016-0. 069
1 Cited from McClure, F. J.: Am. J. Diseased Children 66: 368, table 5, 1943.
2 Figures for weight for ages 1 to 6 years were taken from tables arranged by Woodbury (Woodbury, R. M.,
Statures and Weights of Children Under Six Years of Age, publication 87, U. S. Department of Labor:
Children's Bureau, 1921); figures for 6 to 12 years were taken from the Baldwin- Wood weight-height-age
tables for boys and girls of school age, published by the American Child Health Association.
Lawrenz and Mitchell (1941) found that rats assimilated 20 percent more
fluoride from water than from food. McClure (1949) observed later that when
the animals followed normal eating habits there was no difference in fluoride
assimilation from the two sources.
The method of fluoride assay most widely used for food analysis is that of
Willard and Winter, a modification of which was studied collaboratively by
Clifford (1945) and appears in the Association of Oflicial Agricultural Chemists
Book of Methods. This method is not reliable for food products that are high
in silica, which inhibits the extraction of fluoride. Additional analytical data
are needed to establish further the reliability of average food fluoride values
and their application in specific areas throughout the country.
Fluoride supplement to food. — Whereas there is a reasonably satisfactory
regulation of the total intake of fluoride from drinking water containing 1 part
per million of fluoride, there is as yet no control study to indicate that fluoride
added to other items of the diet would be self-limiting and self-regulatory in
the same way. Furthermore, in view of the already existing practice of fluori-
dating communal water supplies, it is imperative to bear in mind the possibility
that fluoride addition to other food items might become the source of excessive
increments of the individual fluoride intake. However, assuming that fluoride-
supplemented food could reach populations in a controlled manner, the three
categories listed below (from Hodge and Smith, 1953) may be considered for
the purposes of this study as points of reference in evaluating the hazard of
such potential vehicles.
FLUORIDATION OF WATER
479
Category
Dose fre-
quency
Amount of fluoride
Time
Clinical effect
Chronic high-grade poisoning. .
Chronic low-grade poisoning...
Preventive don tistrv
Daily
...do -
...do
20 to 80 milligrams
or more
2 to 8 milligrams
or more.
I to 1.5 milligrams
10 to 20 years
Daily during first
8 years of life.
First 8 years pri-
marily.
(Crippling) skele-
tal lluorosis.
Mottled enamel.
Decreased denta
canes.
One might add a fourth category, acute fatal poisoning, even though it is dif-
ficult to see how any proposed scheme could provide enough food fluoride to
make a fatal outcome possible. As an example, one may assume that fluoride
is added to table salt in amounts sufflcient to provide an additional 1 milligram
of fluoride daily. Two milligrams of NaP contain 1 milligram of fluoride;
assuming a dally intake of 10 grams of NaCl, the salt would contain 0.02 per-
cent NaF. To obtain 2,500 milligrams of fluoride, possibly a fatal dose, it would
be necessary to ingest 2,500X10 grams, or 25 kilograms of salt, which is clearly
impossible. Similar calculations can be made for the amounts of fluoride that
might be taken in if the fluoride were added to other foods. Fatal poisoning is
out of the question.
Furthermore, if the amount of fluoride that might produce crippling fluorosis
in 10 to 20 years is calculated, the indicated daily intake of NaCl would be over
200 grams ; this is out of the question. If the 8 parts per million level is taken
as a plus or minus zone for skeletal changes, there is no cause for disquietude,
because an intake of 80 grams of salt per day is also unthinkable. It is probable
that no symptoms of chronic high-grade poisoning would ever appear, no mat-
ter how many items of the diet contain added fluoride at the recommended level.
In addition, since a person drinking fluoridated water may be assumed to ingest
only about 1 milligram -per day from this source, adding fluoridized foods to the
diets in these communities wotild not be expected to give rise to any symptoms
of chronic high-grade poisoning.
The development of mottled enamle is, how^ever, a potential hazard of adding
fluorides to food. The total daily intake of fluoride is the critical quantity. The
use of fluoridated salt, for example, with the simultaneous use of fluoridated
water, might easily provide amounts of fluoride in excess of the recommended
level. Foods processed with fluoridated water could become an additional source
of extra fluoride unless the total concentration from all sources is considered
and kept within the recommended level. Consideration of the normal variations
in the intake of various types of food at various ages is basic to this problem.
While a considerable amount of information is available regarding the average
caloric intake and the consumption of specific nutrients among American indi-
viduals and family groups, our concern here is primarily to consider quantita-
tive data on the consumption of specific food items by children from infancy to
adolescence. On this point the literature appears to be very limited. One re-
source for such information has been located in the longitudinal group study
which has been going on at the Department of Maternal and Child Health of the
Harvard School of Public Health for the past two decades, but so far this mate-
rial has primarily been calculated with respect to specific nutrients, such as pro-
tein, calcium, etc., because of their more immediate scientific interest. The most
extensive recent study pertinent to the discussion appears to be that of Widdow-
son (1947), which is concerned with individual children's diets in a "middle
class" English group of 435 boys and 481 girls, of all ages from 1 to 18 years.
Although the consumption of specific food items may differ in the United States,
this study gives some idea of individual variations in food intake and the trend
with age. One outstanding significant fact is the finding that "similar indi-
viduals may differ enormously and unpredictably in their food habits." Yet the
great departures from the average food habits reported in this survev appeared
compatible with normal physical development. "These findings," the author con-
cludes, "indicate that individual requirements must differ as much as individual
intakes and tliat an average intake, liowever valuable statistically, should nevei-
be used to assess an individual's requirements."
Specifically, Widdowson noted that the consumption of some foods, .such as
bread, meat, potatoes, and sugar, increased in amounts until the children were
15. whereas such foods as biscuits, cheese, fruit, and green vegetables were
eaten in similar amounts at all ages studied. A fairly constant milk intake of
480 FLUORIDATION OF WATER
approximately four-fifths of a pint was observed in children up to the age of
10, after which the intake declined.
Fish consumption, a potential soui-ce of naturally available fluoride, ranged
from an average of approximately 3 ounces per week in the 1- to 4-year-old
group to approximately 5 ounces per week in the 6- to 12-year-old group, in-
creasing to 8 ounces in the 18-year-old group. Assuming a minimum of 5 parts
per million of fluoride in fish (see above) this would mean a fluoride intake of
0.06 milligram in infants and 0.1 in 12-year-olds per day, only a 10th of the
recommended caries-preventive level.
Expi*essed in grams per day, the average fish consumption in the English
group was about 12 grams in the 1-year-olds, rising to 20 grams in the 12-year-
olds and 32 grams in the 18-year-olds. By comparison, the average fish con-
sumption in the United States has been reported to be approximately 13 grams
per individual per day, in Norway about 50 grams, in Japan 100 grams. This
last figure, reported as the highest in the world (News of Norway 1951),
should provide about 0.5 milligrams of fluoride per individual per day. In one
isolated community, the island of Tristan da Cunha, an average fish consump-
tion of nearly 300 grams per individual, equivalent to about 1.5 milligrams
fluoride per day, has been recorded. Although the water supplies contained
only 0.2 parts per million of fluoride, tlie islanders were found to have a
threshold degree of mottled enamel (Sognnaes, 1941) and an elevated fluoride
content of the teeth (Sognnaes and Armstrong, 1941) close to the amount re-
ported in United States communities with 1 part per million fluoride in the
drinking water (McClure and Likins, 1941).
Widdowson gives quantitative data on the consumption of bread, cereal, milk,
and sugar, all potential vehicles for fluoride supplement. The average bread
consumption ranged from approximately 1% ounces per day in the 1-year-olds
and 4 in the 6-year-olds to 6 in the 12-year-olds. However, the individual range
within each of these age groups was much greater than the difference between
the 1- and 12-year-old averages. The range in the 1-year-old group was thus
0.2 to 3.8 ounces per day, in the 6-year-olds 1.7 to 8.5, and in the 12-year-old
group 1.8 to 12.9 ounces. The approximate consiimption of cereals (expressed in
terms of flour, oatmeal, etc., as purchased) ranged from 2 ounces in the 1-year-
old gi'oup to 4 ounces in the 6-year-olds, increasing to 6 ounces in the 12-year-olds,
and after that remaining approximately the same to the 18-year-old group.
The milk consumption showed more similar averages for each age group ;
approximately 19 oimces per day in the 1-year-olds. 18 in the 6-year-olds, and
12 in the 12-year-olds. But again, there were considerable individual variations
within each age group, ranging from 3.2 to 34.1 ounces in the 1-year-olds, 7.7
to 30.4 in the 6-year-olds, and 3.2 to 28.5 in the 12-year-olds,
The total sugar consumption from all sources (as sugar, sweets, jam, cakes,
puddings, cooked fruits, etc.) increased from approximately 9 ounces per week
in the 1-year-olds and 17 ounces in the 6-yeai'-olds. to 25 ounces in the 12-year-
olds. Sugar as .such contributed in the 1-year-old group an average of 3.8 ounces
per individual per day, in the 6-year-olds 4.4 ounces, increasing to approxi-
mately 9 ounces in the 12-year-olds. The range within each age group was not
given for sugar, but a significant sex difference was noted from 9 years of age
on. when boys, contrai-y to the familiar saying, appeared to eat increasingly
more sweets than girls, more than twice as much between the ages of 15 and
18 years.
From the above, it appears that there are limited data upon which to base the
evaluation of potential fluoride vehicles among common foods. What informa-
tion there is indicates large variations in individual intakes of specific food items
which might possibly serve as fluoride vehicles.
In addition to the inadequacy of the quantitative data on food consumption
at various ages, it must also be made clear that the committee has been able to
find almost no evidence, except for water fluoridation, with regard to the effect
of fluoride supplement on caries in man. Hence, discussion of the addition of
fluoride to food items other than water must be based on certain assumptions
rather than on concrete evidence.
In view of this lack of specific knowledge, any one fluoridated food, other than
water, here considered must be subjected to lengthy experimentation before it
could be put to general use. At the moment the problem can be only tentatively
illustrated by discussing a few representative items within 3 categories: (1)
solid, (2) liquid, and (3) miscellaneous vehicles.
Solid vehicles, among common foods suitable as carriers for fluoride, must
above all meet the requirements of food technology for easy handling and mix-
FLUORIDATION OF WATER 481
ing. Flour, as an example within this category, may be considered a feasible
vehicle from the standpoint of stability and the technology of distribution of the
fluoride uniformly throughout the food. According to the study of Widdowson
(1947) previously referred to, the consumption of cereal increased from approxi-
mately 2 ounces per individual per day in the 1-year-old group to an average of
6 ounces in the 12-year-old. The consumption of bread showed roughly the same
quantitative increase with age. Consequently, the average intake of fluoride if
added to flour, bread, or cereal, would come near to the desired increase with age
from infancy to adolescence. The average daily consumption of flour in this
country is estimated to be similar, or about 6VC> ounces per individual per day in
the adult. Considering the desirable intake of fluoride in older children as 1
milligi-am per day, the approximate amount of fluoride to be incorporated in the
flour could be calculated. However, we have already referred to English observa-
tions suggesting that there are marked individual variations within single age
groups in the consumption of bread. In addition, it is believed, for lack of exact
data, that in the United States bread would not be used to the great extent in
infancy during the early stage of tooth development.
Canned baby food, being so extensively used in the United States, might merit
study as a practical source of fluoride in infancy and early childhood, but the
question may be raised as to whether the distribution is uniform enough in rural
districts and other isolated parts of the country, populations which are precisely
those least likely to have access to water fluoridation. The extent to which the
use of processed baby food actually is used in various locations would have to be
determined if this vehicle proves to have merit otherwise.
Under the heading of liquid vehicles, one would obviously list drinking water
first. It should be stressed again that this is the only vehicle for fluoridation
which can be judged on the basis of prolonged epidemiologic observations as well
as clinical application. The committee is of the opinion, because of the knowl-
edge already available regarding this vehicle, that bottled fluoridated water is
the only source meriting serious consideration as a fluoride supplement whereby
fluoridation could immediately reach communities without a communal water
supply. It is possible, however, that this vehicle, while the most nearly ideal as
such, might be too costly as a source of water supply, in view of the expense of
bottling, distributing, and insuring compliance with sanitary regulations ; this
should be explored further.
Next to bottled water, the mechanics of mixing fluoride to a liquid food vehicle
would appear to be simplest for juices and soups. These vehicles merit atten-
tion because in themselves they contribute valualile nutrients. In addition to
being low in cost, they are conveniently marketed, stable, and used relatively
extensively by various age groups without tending to be consumed in excess.
The pros and cons of adding fluoride to milk have been discussed in a recent
report (Pearlman, 1953). The argument that calcium fluoride would be pro-
duced, and hence make the fluoride ion less available, does not appear to be an
important factor in the concentration of 1 part per million. However, in regard
to distribution, the committee feels that there would be a lack of uniformity of
intake in various parts of the country and that small farms and dairies in rural
districts would have problems in controlling the addition of fluoride to small
quantities of milk. Furthermore, the intake. of milk during the first year of life
would depend on the extent to which the babies are breast fed. Human milk
contains only traces of fluoride, the highest concentration found in one study
(Hodge, et al., unpublished data) being .09 part per million. This means that a
nursing baby drinking approximately 500 cubic centimeters of milk in 1 day
would only receive the negligible amount of 0.045 milligram of fluoride per day,
suggesting that supplementary fluoride through water or baby food should be
considered.
Among miscellaneous vehicles, consideration was given to sugar, salt, and
tablets.
It was felt that sugar is liable to wide variation and excess in usage and would
not satisfy the requirements as to either uniformity of use or self-regulatory
control.
No exact information has been obtained with regard to the consumjjtion of salt
in various age groups. It is not even certain that this vehicle would be practical
from a technical standpoint; it w^ould have to be determined, for instance,
whether the addition of sodium fluoride would be uniform throughout and
whether it would affect unfavorably the antihygroscopic property of the product.
While the daily consumption would have to be determined more exactly, there
482 FLUORIDATION OF WATER
are doubts as to whether this vehicle would serve the purpose for infants and
young children.
On a small scale, there has been some experimentation with the administration
of fluoride in the form of tablets, mainly by professional personnel of the United
States Public Health Service. These data on children, gradually accumulated,
support the contention that this procedure is safe and beneficial ; however, the
data are not yet conclusive. It should also be emphasized that this means of
prescribing fluoride might be safe within a group intimately familiar with the
possible hazards of the problem and would not have general application except
to selected patients on a prescription basis or in a supervised program. The same
restrictions would hold for other potential types of prescribed fluoride, with or
without other nutrients or drugs.
The topical application of fluoride to the teeth does not, strictly speaking, enter
into this discussion of vehicles for fluoridation of the American diet. In this
caries-prophylatic procedure, fluoride is applied by the private dentist or in a
school program, usually as a 2 percent sodium fluoride solution ; i. e., some 10,000
times as concentrated as the dosage recommended for internal use through
water fluoridation. The dentist applies only a small amount to the external sur-
face of the teeth, but the stock solution itself is much too strong to be dispensed
to the layman. A single dose of a few ounces of such a 2 percent solution, if by
accident taken internally and retained, would contain enough fluoride to produce
acute poisoning.
The topical application of fluoride is merely mentioned here to indicate that,
while it is a safe procedure as long as it is in the hands of expertly trained
personnel, the reports on its caries-preventive potentials have not been as fav-
orable or uniform as those on water fluoridation. In addition, it is a relatively
expensive and time-consuming preventive measure compared with community
water fluoridation. The committee is of the opinion that topical application of
fluoride is not a substitute for fluoridation through the drinking water or other
potential vehicles which, during tooth development, can provide an optimal
internal supplement of approximately one-half to 1 milligram of fluoride per
day (see table 3).
IV. SUMMART AND CONCLUSIONS
1. A study has been made of the problem of providing an optimum amount of
fluoride in the American diet.
2. The increasing magnitude of the caries problem and the inadequacy of
conventional preventive methods are stressed.
3. The American diet normally provides less than the optimal caries-preven-
tive amount of fluoride.
4. On the basis of epidemiologic and experimental observations in fluoridated
communities, the most reliable vehicle for supplementing the fluoride intake is
water.
5. The adjustment of the fluoride content of drinking water to 1 part per
million fluoride is in principle and in practice the soundest and most effective
approach to caries prevention on a large scale known today.
6. Next to fluoridated communal water supply, the use of bottled fluoridated
water at 1 part per million, used for cooking and drinking as the exclusive
source of water, is the only supplement which could immediately be put to use
on the strength of present evidence in regard to amount of fluoride ingested
and caries-preventive effect in man.
7. Other vehicles, liquid or solid, cannot at present be recommended but merit
further study with respect to consumption, technique of fluoridation, distribu-
tion, and effectiveness.
8. In order to determine the value of other dietary fluoride vehicles, addi-
tional studies are recommended on food and water consumption from infancy
to adolescence and on the metabolism of food-borne versus water-borne fluorides.
9. If any vehicle, upon further study, should prove to be promising, it is
imperative that such vehicle be subjected to adequately controlled clinical
studies in humans before any large-scale application is made.
Literature References
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Research 21 : 326, 1942.
Arnold, F. A., Jr., H. T. Dean, and J. W. Knutson. Effect of fluoridated public
water supplies on dental caries prevalence. U.S. Pub. Health Repts. 68 : 141-
148, 1953.
FLUORIDATION OF WATER 483
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Bartholomew, R. P. Fluorine, its eff'ect on plant growth and its relation to
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Blue, J. A. Mottled enamel in Oklahoma Panhandle and its possible relation
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Brekhus, p. J. The deterioration of human teeth. J. Am. Dental Assoc.
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Dean, H. T. Fluoridation: Mass control for dental caries. Am. J. Nursing
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Ham, M. p. and M. D. Smith. Fluoride studies i-elated to the human diet. Can.
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published data.
Hodge, H. C, and F. A. Smith. Some public health aspects of water fluorida-
tion. Am. Assoc. Advancement Sci. Washington, 1953. (In press.)
Hodges, P. C, O. J. Fareed, G. Ruggy, and J. S. Chudnoff. Skeletal sclerosis
in chronic sodium fluoride poisioning. J. Am. Med. Assoc. 117 : 1938, 1941.
Krikos, a. The progress of decay in Greece from the most ancient times down
to the present. Trans, of the Am. Dent. Soc. of Europe, 1935.
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fluorine-bearing minerals and food (tea) and from water and food. J. Nutri-
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Machle, W., E. W. Scott, and J. Teeon. Normal urinary fluorine excretion and
the fluorine content of food and water. Am. J. Ilyg. 29 : 139, 1939.
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of uranium compounds. Part III. New York. McGraw-Hill Book Co., Inc.,
1953.
McCluee, F. J. Fluorides in food and drinking water. Natl. Inst. Health Bull.
172 : 1, 1939.
McClure, F. J. Ingestion of fluoride and dental caries. Am. J. Diseases Chil-
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pp. 74-92 in Dental Caries and Fluorine, F. R. Moulton, ed. Am. Assoc. Ad-
vancement Sci. Washington, 1946.
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Repts. 64 : 1001-1074, 1949.
McClure, F. J. and R: C. Likins. Fluorine in human teeth studied in relation
to fluoride in the drinking water. J. Dental Reserch 30: 172-176, 19.51.
Moen, B. D. Bureau of Economic Research and Statistics : Survey of needs for
dental care. V. Dental n('ed,s according to Income and Occupation. J. Am.
Dental Assoc. 47 : 340-348, 19.53.
News of Norway. Notice on Fish Consumption. Norwegian Information Serv-
ice 8 : 100, 1951.
Pearlman, S. Untested alternatives to fluoridation of domestic water supplies.
J. Am. Dental Assoc. 46 : 287-289, 1953.
Remmeet, L. F. and T. D. Parks. Determination of fluorine in plant materials.
Anal. Chem. 25 : 450, 1953.
Roholm, K. Fluorine Intoxication. A clinical-hygienic study with a review of
the literature and some experimental investigations. London. H. K. Lewis
& Co., Ltd., 1937, 364 pp.
Savchuck, W. B. and W. D. Armstrong. Metabolic turnover of fluoride by the
skeleton of the rat. J. Biol. Chem. 193 : 575-585, 1951.
484 FLUORIDATION OF WATER
SCHLESiNGER, E. R., D. E. OvERTON, and H. C. Chase. Newburg-Kingston caries
fluorine study. V. Pediatric aspects, Continuation Report. Am. J. Pub.
Health 43 : 1011-1015, 1953.
Shimkin, M. B., F. a. Arnold, Jr., J. W. Hawkins, and H. T. Dean. Medical
aspects of fluorosis : A survey of 114 individuals using w^ater with 8 parts per
million fluoride and of 131 individuals using water with 0.4 parts per million
fluoride. Am. Assoc. Advancement Sci. 1953. (In press)
Smith, F. A. cf. H. C. Hodge, and G. J. Cox. Fluorine Chemistry, Vol. II, Chapter
5, edited by J. H. Simons. New York. Academic Press, 1953. (In press)
Smith, F. A., D. E. Gardner, and H. C. Hodge. Age increase in fluoride content
in human bone. Federation Proc. 12 : 368, 1953.
Smith, H. W., M. C. Smith, and M. Vavich. Fluorine in milk, plant foods, and
foods cooked in fluorine-containing water. Ariz. Agr. Exp. Sta. mimeographed
rep., 1945. 6 pp.
Sognnaes, R. F. A condition suggestive of threshold dental fluorosis observed in
Tristan da Cunha. Part I. Clinical condition of the teeth. J. Dental Research
20 : 303-313, 1941.
Sognnaes, R. F., and W. D Armstrong. A condition suggestive of threshold
dental fluorosis observed in Tristan da Cunha. Part II. Fluorine content of
the teeth. J. Dental Research 20 : 315-322, 1941.
United Kingdom Mission's Report on the fluoridation of domestic water supplies
in North America as a means of controlling dental caries. Ministry of Health,
Department of Health for Scotland ; Ministry of Housing and Local Govern-
ment. London. Her Majesty's Stationery Office, 1953.
Widdowson, E. M. a study of individual children's diets. Medical Research
Council, Special Report Series No. 257. London. His Majesty's Stationery
Office, 1947.
(The following additional material was snbmitted for the record :)
Hasbrouck Heights, N. .T., Jfme SI, lOSJ/.
Hon. Charles A. Wolverton,
House Office Building, Washington, D. C.
Dear Sir : I am very converned about bill H. R. 2341, titled "To protect the
public health from the dangers of fluoridation of water" which will come up for
your con.sideration. For the past 10 to 12 years I have read extensively on this
topic and have come to the opinion that there is no other single step that can
improve dental health like the fluoridation of communal water supplies can
and will do. The evidence is overwhelmingly in favor of fluoridation. Please
file this correspondence for the record. I am very much in favor of fluoridation.
Yoiu-s trulv,
S. J. Fanale, D. D. S.
State of California,
Department of Public Health,
San Francisco, Calif., May 25, 195ff.
Hon. Carl HinShaw,
Intcrfitate and Foreign Commerce Commitiee,
House of Representatives, Washington, D. C.
My Dear Mr. Hinshaw : As the director of the California State Department of
Public Health and the president of the California State Board of Public Health,
we respectfully submit the position of the department and the board on the
fluoridation of public water supplies.
The department of public health has made a thorough study and critical evalu-
ation of the great mass of scientific data concerning fluorine and its compounds
in relation to water fluoridation, the physiological effects of fluorides on the
human body, and the relationship of fluorides to dental caries.
It is the considered opinion of the department and the board that the controlled
fluoridation of public water supplies is a safe and economical public-health
measure for the partial prevention of dental caries. (See attachment.)
Approximately 3,600,000 people in California have been drinking water con-
taining 0.5 parts per million or more of fluoride for many years. At present
14 cities in California have adjusted the fluoride level of their public water sup-
plies to a concentration beneficial to the health of their citizens. Thus, 34
percent, or approximately 4,747,000 people in California, are drinking fluoridated
water.
FLUORIDATION OF WATER 485
The California State Board of Public Health and the California Department of
Public Health hold the view that the decision with respect to fluoridation of
public water supplies must be the prerogative of tlie local community. In ac-
cordance witli this view, the board and the department liave set standards and
procedures under which communities desiring to fluoridate their water supplies
may obtain a permit to do so. While the board and the department would not
favor coercing a community to fluoridate its water, the board and the depart-
ment believe that no community should be prevented from fluoridating if it
wishes to do so.
House of Representatives bill No. 2341 disregards the great preponderance of
scientific evidence on fluoridation.
House of Representatives bill No. 2341 would deprive communities in Cali-
fornia of their prerogative of local decision on a proven public-health measure.
The California State board and the department of public health respectfully
request your honorable committee to carefully weigh the evidence on fluorida-
tion of public water supplies. They liope that the committee will then deem it
appropriate in the furtherance of public health in the Nation to oppose the legis-
lation referred to herein as House of Representatives bill No. 2341.
Respectfully submitted.
Malcolm H. Merrill, M. D.,
Director of Public Health.
Charles E. Smith, M. D.,
President, California State Board of Public Health.
State of California
Department of Public Health
san francisco, calif.
Notice of Policy Statement and Resolution ky the State Board of Public
Health With Respect to the Fluoridation of Public Water Supplies
On August 29, 1950, the State board of public health formally stated its policy
on the question of adding fluoride to public water supplies in California for the
partial control of dental caries.
On September 14, 1951, the board reaffirmed its policy in a resolution, with
particular reference to the authority of the State department of public health
to grant permits for public water supplies to which fluoride will be added.
The policy statement and the subsequent resolution are set forth in this leaflet
as they appear in the minutes of board meetings held on the two dates cited.
Malcolm H. Merrill, M. D.,
Acting Executive Officer, State Board of Public Health.
Statement by the State Board of Public Health
(Approved on August 29, 1950)
'llie California State Board of I'ublic Health approves the fluoridation of
public water supplies for the partial control of dental caries providing that
the local dental and medical societies also approve.
Details for accomplishing fluoridation must be reviewed in each instance by the
State department of public health under the provisions of the California pure
water law. (See ch. 7, pt. 1, division 5. Health and Safety Code.)
Resolution of the State Board of Public Health
(Adopted on September 14, 1951)
Whereas on August 29, 1950, the State board of public health issued a statement
of policy apiTroving the addition of fluoride to public water supplies in this
State subject to prior approval of the local dental and medical associations ; and
Whereas the legislature considered at the 1951 session a bill, a portion of
which specifically authorized purveyors of public water supplies, including
utility and irrigation districts, to add fluoride to their water supplies under
permit from the State department of public health ; and
Whereas this portion of that bill was not passed by the legislature and this
fact has raised doubts in many persons' minds as to the present legality of
486 FLUORIDATION OF WATER
fluoridation of water supplies other tlian bottled water supplies in California ;
and
Whereas the attorney general's office has advised the State department of
public health that under existing statute there is no doubt that the department
has authority to grant permits for addition of a beneficial mineral nonexistent
or insufficient in those public water supplies not naturally endowed, if it finds
that such treated water supplies will under all circumstances and conditions
be pure, wholesome, and beneficial to health : Now, therefore, be it
Resolved, That the State board of public health finds that fluoridation of
public water supplies by the placing a normal and beneficial mineral in proper
concentration in those supplies in which it does not occur in optimum amounts
naturally, will tend to produce a water that imder all circumstances and con-
ditions is pure, wholesome, potable, and beneficial to health ; and be it further
Resolved, That the State board of public health herein reaffirms its policy
statement of August 29, 1950, approving the fluoridation of public water supplies.
Resolution of the State Board of Public Health
(Adopted on April 29, 1952)
Whereas on August 29, 1950, the State board of public health issued a state-
ment of policy approving the addition of fluoride to public water supplies in
this State subject to prior approval of the local dental and medical associations,
and on September 14, 1951, reaffirmed that policy, which statement of policy in-
dicated its feeling that properly controlled fluoridation of public water sup-
plies was appropriate ; and
Whereas there have been some legal discussions misinterpreting the force and
effect of these resolutions accusing the board of illegally delegating its powers ;
and
Whereas the board is fully aware of its powers under the Health and Safety
Code and under no circumstances has delegated any of its powers with respect
to fluoridation of public water supplies, but has desired to have the local area
involved express by its medical and dental societies their local feeling concerning
fluoridation ; and
Whereas no authorization for permit to fluoridate is granted without proper
application pursuant to the provisions of the Health and Safety Code: There-
fore, be it
Resolved, That the board desired it distinctly understood that under no cir-
cumstances has it delegated any of its power and authority with respect to per-
mits to fluoride public water supplies to anyone and will grant permits to
fluoridate upon proper application made pursuant to the Health and Safety Code.
Lakeland, Fla., May 1, 195.!/.
Re our position — for the proposed H. R. 2341 to be enacted.
Hon. Chaeles A. Wolverton,
Chairman, House Interstate and Foreign Cotnmerce Committee,
House Office Building, Washington, D. C.
Gentlemen : As chairman of the Florida Statewide Committee of the Pure
Water Association of America, and thus representing thousands of citizens of
the State of Florida, who are against fluoridation of public water supplies, I sub-
mit the following statements for your consideration and respectfully request that
it be filed as our proposed testimony during hearings of H. R. 2341.
We are asking your support of the Wier bill, H. R. 2.341, to prohibit the addition
of sodium fiuoride in any form, by any means, and for any alleged purpose.
We support this bill as it now reads because :
1. We believe pure drinking water should come from our city reservoirs and
that poison chemicals for human consumption should be sold in drugstores by
licensed pharmacists.
2. We insist upon exercise of our right to be secure in our homes and persons ;
to choose our own physician, our own medicine, and manner of taking it.
3. We stand upon our right accorded us by laws of this country to subject our
bodies to experimentation either mass or individual, only if and when we choose
to do so and then only by written permission. Compulsory medication (or ex-
perimentation) is contrary to the fundamental freedom of Americans, and con-
trary to the wishes and needs of each individual.
FLUORIDATION OF WATER 487
4. Mass medication (fluoridation of public watci- supplies) ignores the indi-
vidual patient-physician relationship (or dentist-patient relationship).
5. Tooth decay is an outward manifestation of body degeneration or metabolic
dysfunction. Prevention of tooth decay by proper oral hygiene and proper at-
tention to general health measures, including proper choice of vital foods, is the
preferred method recommended by most physicians and dentists.
6. The proponents disi-egard the fact that fluorine is a cumulative poison.
7. Because of the destructive power of fluorides on the enzyme system of the
body and possible harm to the soft and osseous tissues of the human body.
8. Individual differences (susceptibilities) preclude any "average dose" for
total populations being applied through the public drinking-water supplies.
9. It is uneconomical. The expense for fluoridation is sta.i^gerini; when one
takes into account personnel in Federal, State, county, and community levels,
for chemists, supervisors, public relations, printing, machinery, chemicals, and
laboratories, when only about 2 percent of the fluoridated water will reach the
children for whom it is intended.
10. It is unwarranted because for a few cents parents can purchase this
chemical in an approved forn» from the druggist with a properly executed pre-
scription from the dentist or physician who will then be responsible to that parent
for what happens to the child — should that child be susceptible. The dentist
can also use the topical application of fluorides.
11. It is unethical and illegal because city councils and waterworks depart-
ments are not licensed to prescribe medical treatment or to dispense treatment
to anyone — individually or en masse.
12. It is unscientific because each individual is a law unto himself and the
physician is the first to tell his patient that he needs treatment designed for his
specific trouble.
13. Because it opens the door for other forms of mass medication through the
public water supplies. Once instituted and accepted fluoridation would have
sabotaged the one law we have designed to protect us in our food and drink,
and set a precedent by which we would have to abide for future medication
through public water supplies.
14. Because these are .such critical days for our Nation and we need to give
our time, energy, and resources to promoting unity, harmonious relations, and
civil defense, and because we are prevented from doing so due to the fact that
we are continually harassed by the proponents in their attempt to force fluorida-
tion upon us.
15. Because such monumental sums of our national tax money have been
spent and continue to be spent to propagandize for fluoridation, and because
citizens who neither need nor want to take sodium fluoride must of necessity
spend additional sums to protect themselves against fluoridation proponents —
who continually violate our decisions against this compulsory measure.
16. Because fluoridation of public water supplies imposes a harsh and undue
hardship upon all citizens who oppose drinking fluorides by forcing them to —
(a) Spend an average of $135 annually for bottled water fluorine free for
a family of 3 for all cooking and drinking purposes.
(&) Send their children to other colleges — which might, and often do,
charge more than the State university, which is frequently fluoridated
(thereby forcing all the young adults to drink this poison chemical without
any recourse even when they are told it can do them no good, and they know
it could prove detrimental). This extra expenditure is unwarranted and
more often than not can be ill afforded.
17. Because the (a) efficacy of fluoi'ides ; (&) the proposed dilution of this
I>oison chemical; (c) number of communities using fluorides or not using
fluorides; (d) whether artificial or natural fluorides are or are not identical;
(e) whether everyone in America does or does not have decayed teeth; (/) and
regardless how many scientists, dentists, or bureaus do or do not endorse
fluoridation — (all of this) is entirely beside the point. The point in this issue
is — it would be compulsory experimental mass medication to which the public
under our Constitution does not have to subject itself — and because their laws
do not empower our city officials to use communal water supplies as carrier for
medication.
18. Because we find ourselves in desperate need of legal protection to end this
most controversial of all subjects — compulsory mass medication (fluoridation)
and thus give us surcease from harassment ; physical and financial expenditures;
and from mental-distress cases, wherein many are already physically afflicted
488 FLUORIDATION OF WATER
and fear damage from this poison chemical which they must ingest for the rest
of their lives.
We, therefore, urge you to support this bill, H. R. 2341, and do all you can to
pass it.
Sincerely,
Mrs. HJERMAN J. KUPPERS,
State Chairman, Florida State-Wide Committee of the Pure Water
Association of America.
(Communications have been received from the following expressing opposition
to the enactment of H. R. 2.341, to protect the public healtli from the dangers
of fluoridation of water:)
Health Departments by States
Alabama :
Dr. William L. Scholes, director, Dental Division, Montgomery
Dr. D. G. Gill, State health oflScer, Montgomery
Arkansas: State Board of Health, Dr. John T. Herron, M. D., State health
officer, Little Rocli
Cajlifornia : Dr. Malcolm H. Merrill, M. D., director of public health, San
Francisco
Colorado : Dr. R. L. Cleere, executive director, Department of Public Health,
Denver
Connecticut : Franklin M. Erlenback, D. M. D., Department of Health, Hartford
Georgia :
John E. Chrietzberg, D. D. S., Department of Public Health, Atlanta
Dr. T. F. Sellers, M. D., Department of Public Health, Atlanta
Hawaii (Territory of) : Board of health, Dr. Richard K. Lee, M. D., Honolulu
Idaho : L. J. Peterson, M. S. P. H., Department of Public Health, Boise
Illinois :
Dr. J. W. Krupicka, D. D. S., State Department of Public Health, Rock Island
Cyril L. Friend, D. D. S., Department of Public Health, Carbondale
Dr. Norman J. Rose, Department of Public Health, Springfield
John E. Zur. D. D. S., Department of Public Health, Springfield
Dr. Leonard M. Schuman, Department of Public Health, Springfield
Northeastern regional office. Department of Public Health, Robert L. Hass,
D. D. S., Aurora
Orvis S. Hoag, D. D. S.. Department of Public Health, Springfield
Indiana : Roy D. Smiley, D. D. S., State Board of Health, Indianapolis
Iowa : Charles H. Henshaw, D. D. S., Department of Health, Des Moines
Kansas : Dr. Thomas R. Hood, Kansas State Board of Health, Topeka
Maryland : Richard C. Leonard. D. D. S., Department of Health, Baltimore
Massachusetts : Dr. Samuel B. Kirkwood, commissioner, Department of Public
Health, Boston
Michigan : Fred Wertheimer, D. D. S., Department of Health, Lansing
Minnesota :
Dr. A. J. Chesley, Minnesota Department of Health, Minneapolis
William A. 3'ordan, D. D. S., Minnesota Department of Health. Minneapolis
Missouri :
Dr. J. Earl Smith, D. D., Department of Public Welfare, Division of Health
(health commissioner), St. Louis
C. E. Presnell, D. D. S., Division of Health, Jefferson City
Nebraska : H. W. Heinz. D. D. S.. Departmenfof Health. Lincoln
Nevada : O. M. Seifert. D. D. S.. Department of Health. Reno
New Jersey: Dr. Daniel Bergsman, Department of Health, Trenton
New York : Herman E. Hilleboe, M. D., Department of Health, Albany
North Dakota : E. C. Linscheld. D. D. S.. Department of Health, Bismarck
Ohio : H. B. Millhoff, D. D. S.. Deparfment of Health, Columbus
Oklahoma : Frank P. Bertram. D. D. S.. Department of Health, Oklahoma City
Oregon : David M. Witter. D. D. S., State Board of Health, Portland
Pennsylvania : Dr. Russell E. Teague, M. D.. Department of Health, Harrisburg
South'Carolina : Dr. Ben F. Wyman, State Health Officer, Columbia
FLUORIDATION OF WATER 489
Tennessee :
R. H. Hutcheson, M. D., Department of Public Health, Nashville
Carl L. Sebelius, D. D. S., Department of I'ublio Health, Nashville
Texas : Edward Taylor, D. D. S., Department of Health, Austin
Utah : George A. Spendlove, Director of Public Health, Salt Lake City
"Washington : Olin E. Hoffman, D. D. S., Department of Health, Seattle
West Virginia : James W. Ruble, D. D. S., Department of Health, Charleston
Wisconsin : F. A. Bull, D. D. S., Board of Health, Madison
(Communications have been received from the following expressing opposition
to the enactment of H. R. 2341, to protect the public health from the dangers of
fluoridation of water) :
Dental Associations by States
Alabama : Frank A. Finney, Jr., Alabama Dental Association, Gadsden
Alaska (Territory of) : Charles J. Pearson, D. M. D., secretary, Alaska Terri-
torial Dental Society, 500 K Street
Arizona : R. K. Trueblood, D. D. S., Arizona State Dental Board, Glendale
California :
Lawrence R. Ludwigsen, D. D. S., California State Dental Association, San
Francisco
J. Leonard Schmitz, D. D. S., San Francisco Dental Society, San Francisco
Connecticut :
Earle S. Arnold, D. D. S., Connecticut State Dental Association, West
Hartford
Alfred J. Gengras, Jr., D. M. D., Connecticut State Dental Association, West
Hartford
District of Columbia : Z. Bernard Lloyd, D. D. S., District of Columbia Dental
Society, Washington
Georgia : H. HaiTey Payne, Georgia Dental Association, Atlanta
Illinois : Paul W. Clopper, D. D. S., Illinois State Dental Society, Peoria
Indiana : E. E. Ewbank, D. D. S., Indiana State Dental Association, Kingman
Kansas : Dr. Dan A. Hedge, Kansas State Dental Association, Hoisington
Louisiana : Dr. Julian S. Bernhard, Louisiana State Dental Society, Shreveport
Maine : Alonzo H. Garcelon, D. D. S., Maine Dental Society, Augusta
Maryland : Dr. Morris Cramer, Maryland State Dental Association, Baltimore
Massachusetts :
Harold E. Tingley, D. M. D., Massachusetts Dental Society, Boston
Maurice F. Grossman, D. D. S., Massachusetts Dental Society, Lawrence
]Michigan :
H. Leon Snow, Michigan State Dental Association, Lansing
Charles W. Harling, D. D. S., Detroit District Dental Society, Detroit
Minnesota :
Milton G. Walls, D. D. S., Minnesota State Dental As.sociation, St. Paul
Lorin B. Hodgson, D. D. S., West Central District Dental Society, Breck-
enridge
Missouri :
E. D. Suggett, D. D. S., Missouri State Dental Association, Jefferson City
D. W. Brock, president, Missouri State Dental Association, St. Louis
W. Wayne White, Missouri State Dental Association, Kansas City
Montana :
E. G. Vedova, D. D. S., Montana State Dental Association, Billings
R. D. Curry, D. D. S., Montana State Dental Association, Billings
Nebraska : F. A. Pierson, D. D. S., Nebraska State Dental Association, Lincoln
Nevada : R. J. LaFond, D. D. S., Nevada State Dental Society, Reno
New Hampshire : Floyd E. Williams, New Hampshire Dental Society, Manchester
New Jersey :
John G. Carr, D. D. S., the New Jersey State Dental Society, Camden
Milton B. Asbell, D. D. S., Southern Dental Society of New Jersey
New York : Charles A. Wilkie, D. D. S., the Dental Society of the State of New
York, Buffalo
North Carolina : Dr. Neal SheflSeld, North Carolina Dental Society, Greensboro
490 FLUORIDATION OF WATER
North Dakota: Victor B. Keltgen, D, D. S., North Dakota State Dental
Association, Fargo
Ohio:
H. J. Hoppe, Ohio State Dental Association, Cleveland
Raymond L. Cummins, D. D. S., Ohio State Dental Association, Columbus
S. A. Schmid, president, Ohio State Dental Association, Cincinnati
Oklahoma : Dean Robertson, D. D. S., Oklahoma State Dental Association, Okla-
homa City
Oregon : Thomas D. Holder, D. M. D., Oregon State Dental Association, Portland
Pennsylvania :
Homer Butts, D. D. S., Pennsylvania State Dental Society, Harrisburg
Charles S. Gaige, D. D. S., Pennsylvania State Dental Society, Lancaster
Rhode Island : Bernard C. Friedman, D. M. D., Rhode Island State Dental Society,
Newport
South Dakota :
Dr. Leo N. Thelen, South Dakota State Dental Society, Sioux Falls
M. J. May, D. D. S., South Dakota State Dental Society, Rapid City
Tennessee : Wayne L. McCulley, D. D. S., Tennessee State Dental Association,
Nashville
Utah : R. C. Dalgleish, D. D. S., Utah State Dental Association, 124 State Capitol
Building
Virginia : W. T. McAfee, Virginia State Dental Association, Roanoke
Wisconsin : Charles J. Baumann, Sr., D. D. S., Wisconsin State Dental Society,
Milwaukee
Wyoming :
C. H. Carpenter, D. D. S., Wyoming State Dental Association, Casper
T. J. Drew, D. D. S., Wyoming State Dental Association, Cheyenne
(Communications have been received from the following expressing
opposition to the enactment of H. E. 2341 :)
Harley L. Robertson, president, the Society of State Directors of Health, Physi-
cal Education and Recreation, Old Capital Building, Olympia, Wash.
Dr. Charles E. Smith, University of California, School of Public Health, Berke-
ley.
Ralph E. Carter, mayor, city of Vancouver, Wash.
L. Renter Blevins, D. D. S., president, Virginia State Society of Dentistry for
Children, Arlington, Va.
J. L. T. Appleton, professor of microbiology. University of Pennsylvania, Phila-
delphia
Mrs. Leonard E. Moody, Village Improvement Association, Cranford, N. J.
Russell A. Dixon, dean, Howard University, Washington, D. C.
Gerald J. Cox, Ph. D., University of Pittsburgh, Pittsburgh, Pa.
Dr. C. F. Leonard, East Side Health District, East St. Louis, 111.
James H. Shaw, Ph. D., assistant professor. Harvard School of Dental Medicine,
Boston, Mass.
R. W. Bimting, dean. School of Dentistry, University of Michigan, Ann Arbor
Harold Barnes, D. D. S., American Society of Dentistry for Children, North
Hollywood
Frank D. Paul, D. M. D., Essex County Dental Society, Montclair, N. J.
H. H. Mitchell, professor of Animal Nutrition, University of Illinois, Urbana
Dr. W. B. Prothro, city of Grand Rapids, public health director, Michigan
Alfred .1. Cilella, city council, city hall, Chicago, 111.
Francis Lehr, D. D. S., New Jersey Society of Dentistry for Children, Elizabeth,
N. J.
Rodger E. Poole, D. D. S., New Jersey Society of Dentistry for Children, Upper
Montclair, N. J.
Francis B. Elder, the American Public Health Association, 1790 Broadway, New
York City
H. Berton McCauley, D. D. S., Maryland Society of Dentistry for Children,
Towson, Md.
La Rue L. Miller, Michigan Public Health Association, Inc., Lansing, Mich.
O. W. Brandhorst, American College of Dentists, St. Louis, Mo.
Dr. A. O. DeWeese, American School Health Association, Kent State University,
Kent, Ohio
Henry S. Frank, professor of chemistry. University of Pittsburgh, Pittsburgh
FLUORIDATION OF WATER 491
Donald E. Eagles, North Dakota Hospital Service Association, Fargo, N. Dak,
S. J. Kreshover, D. D. S., Medical College of Virginia, Richmond
Charles F. Kerr, department of education, division of health education, Nash-
ville, Tenn.
W. P. Anderson, M. D., Medical Society of the State of New York, New York
City
R. R. Rosell, Minnesota State Medical Association, St. Paul, Minn.
Dr. Nils P. Larsen, Hawaii Medical Assocition, Honolulu, T. H.
Dr. Cyrus W. Anderson, Colorado State Medical Society, Denver, Colo.
Harold K. Jack, supervisor, State board of education, Richmond, Va.
H. J. Blum, health officer. Contra Costa County, Martinez, Calif.
Dr. R. L. Dunton, president, Minnesota District Dental Society, Minneapolis,
Minn.
Dr. J. B. Askew, director of public health, county of San Diego, Calif.
Dr. R. B. Moyer, secretary. Central Ohio Dental Society
G. W. Solf roiik, D. D. S., Chicago Dental Society, Chicago 2, 111.
Dr. E. R. Krumbiegel, commissioner of health, Milwaukee, Wis.
Harry W. Bruce, Jr., D, D, S., Chattanooga-Hamilton County Health Department,
Tennessee
Polly Ayers, D. D. S., director. Bureau of Dental Health, Birmingham, Ala.
Dr. Ellis D. Sox, director of public health, San Francisco
Dr. Jack Allen Rice, president, Idaho State Dental Association, Coeur D'Alene,
Idaho
Mr. Hale. The Chair has been requested to announce that Dr. Spira
will have an opportunit}^ to use the committee room for a display of
lantern slides to anybody who is interested to see them.
The committee stands adjourned until tomorrow morning at 10
o'clock.
(Wliereupon, at 4:30 p. m., the hearing was adjourned.)
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